Provider First Line Business Practice Location Address:
1021 W 9TH 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:
97058-1007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-298-1920
Provider Business Practice Location Address Fax Number:
541-298-1917
Provider Enumeration Date:
09/12/2016