Provider First Line Business Practice Location Address:
414 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
THE DALLES
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97058-2262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-980-5372
Provider Business Practice Location Address Fax Number:
541-296-4500
Provider Enumeration Date:
11/30/2006