Provider First Line Business Practice Location Address:
808 ADAMS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANDE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97850-2253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-963-2014
Provider Business Practice Location Address Fax Number:
541-963-8901
Provider Enumeration Date:
12/29/2006