Provider First Line Business Practice Location Address:
208 STATE STREET
Provider Second Line Business Practice Location Address:
SUITE #2
Provider Business Practice Location Address City Name:
HOOD RIVER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97031-2036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-241-6276
Provider Business Practice Location Address Fax Number:
360-844-5184
Provider Enumeration Date:
06/17/2009