Provider First Line Business Practice Location Address:
419 SW 5TH 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:
97801-2020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-429-4940
Provider Business Practice Location Address Fax Number:
541-429-4941
Provider Enumeration Date:
01/23/2025