Provider First Line Business Practice Location Address:
328 SW 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:
97801-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-2900
Provider Business Practice Location Address Fax Number:
541-429-4410
Provider Enumeration Date:
09/24/2009