Provider First Line Business Practice Location Address:
ONE UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
FIELD HOUSE, 213
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:
928-606-8274
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2018