Provider First Line Business Practice Location Address:
920 SW FRAZER AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PENDLETON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97801-2839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-278-8600
Provider Business Practice Location Address Fax Number:
541-278-8600
Provider Enumeration Date:
08/16/2007