Provider First Line Business Practice Location Address:
416 NW 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENDLETON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97801-1332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-389-5570
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2015