Provider First Line Business Practice Location Address:
1810 E 19TH ST STE 225
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THE DALLES
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97058-3388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-296-6101
Provider Business Practice Location Address Fax Number:
541-296-3741
Provider Enumeration Date:
06/11/2008