Provider First Line Business Practice Location Address:
704 COLUMBIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOOD RIVER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97031-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-490-7399
Provider Business Practice Location Address Fax Number:
503-914-6678
Provider Enumeration Date:
11/29/2011