Provider First Line Business Practice Location Address:
409 SW 4TH ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
PENDLETON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97801-2068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-1097
Provider Business Practice Location Address Fax Number:
541-966-9713
Provider Enumeration Date:
10/04/2006