Provider First Line Business Practice Location Address:
816 SE 15TH 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:
97801-3254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-5433
Provider Business Practice Location Address Fax Number:
541-276-8605
Provider Enumeration Date:
01/16/2014