Provider First Line Business Practice Location Address:
1514 SE COURT AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-4160
Provider Business Practice Location Address Fax Number:
541-276-2860
Provider Enumeration Date:
01/16/2007