Provider First Line Business Practice Location Address:
420 SE 17TH 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:
97801-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-4100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2010