Provider First Line Business Practice Location Address:
201 SW 20TH ST STE 1
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:
97801-1864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-278-4285
Provider Business Practice Location Address Fax Number:
541-278-4288
Provider Enumeration Date:
03/31/2022