Provider First Line Business Practice Location Address:
119 E 2ND ST
Provider Second Line Business Practice Location Address:
#208
Provider Business Practice Location Address City Name:
THE DALLES
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97058-1796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-298-5000
Provider Business Practice Location Address Fax Number:
541-296-3296
Provider Enumeration Date:
12/05/2006