Provider First Line Business Practice Location Address:
1825 E. 19TH ST
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-506-6940
Provider Business Practice Location Address Fax Number:
541-506-6937
Provider Enumeration Date:
07/06/2006