Provider First Line Business Practice Location Address:
1700 12TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HOOD RIVER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97031-9540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-386-1006
Provider Business Practice Location Address Fax Number:
541-386-1284
Provider Enumeration Date:
11/02/2009