Provider First Line Business Practice Location Address:
1210 DRY HOLLOW RD STE 4 1/2
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:
97058-3102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-422-3212
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2018