Provider First Line Business Practice Location Address:
1416 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:
97801-3215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-4100
Provider Business Practice Location Address Fax Number:
541-278-6564
Provider Enumeration Date:
04/10/2015