Provider First Line Business Practice Location Address:
914 NW 6TH 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:
97801-1324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-969-2129
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/23/2019