Provider First Line Business Practice Location Address:
710 SUNSET DR
Provider Second Line Business Practice Location Address:
PEDIATRICS SUITE
Provider Business Practice Location Address City Name:
LA GRANDE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97850-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-663-3100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2016