Provider First Line Business Practice Location Address:
809 SW COURT AVE
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:
97801-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-3241
Provider Business Practice Location Address Fax Number:
541-276-6423
Provider Enumeration Date:
07/28/2006