Provider First Line Business Practice Location Address:
508 WASHINGTON ST STE 13
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:
97058-2232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-316-0787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2019