Provider First Line Business Practice Location Address:
2203 SW COURT PL
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:
97801-1896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-2905
Provider Business Practice Location Address Fax Number:
541-276-2918
Provider Enumeration Date:
05/18/2023