Provider First Line Business Practice Location Address:
301 SW 20TH 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:
97801-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-966-6293
Provider Business Practice Location Address Fax Number:
541-278-3427
Provider Enumeration Date:
01/11/2007