Provider First Line Business Practice Location Address:
1815 E 19TH ST STE B
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:
97058-3385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-316-6575
Provider Business Practice Location Address Fax Number:
412-108-9135
Provider Enumeration Date:
04/08/2015