Provider First Line Business Practice Location Address:
301 SW 28TH DRIVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-278-0666
Provider Business Practice Location Address Fax Number:
541-278-1578
Provider Enumeration Date:
10/01/2007