Provider First Line Business Practice Location Address:
710 SUNSET DR STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANDE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-663-3100
Provider Business Practice Location Address Fax Number:
541-975-5135
Provider Enumeration Date:
10/28/2005