Provider First Line Business Practice Location Address:
1800 E 19TH ST
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:
97058-3389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-506-6430
Provider Business Practice Location Address Fax Number:
540-506-6431
Provider Enumeration Date:
09/15/2009