Provider First Line Business Practice Location Address:
1400 W 6TH 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:
97058-3520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-298-5680
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2017