Provider First Line Business Practice Location Address:
1600 SE COURT PL
Provider Second Line Business Practice Location Address:
STE 114
Provider Business Practice Location Address City Name:
PENDLETON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97801-3281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-966-0571
Provider Business Practice Location Address Fax Number:
541-966-0574
Provider Enumeration Date:
08/19/2011