Provider First Line Business Practice Location Address:
520 MOUNT HOOD ST
Provider Second Line Business Practice Location Address:
SAFEWAY PHARMACY 1489
Provider Business Practice Location Address City Name:
THE DALLES
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97058-3555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-298-9634
Provider Business Practice Location Address Fax Number:
541-298-9638
Provider Enumeration Date:
05/12/2011