Provider First Line Business Practice Location Address:
1525 W 12TH 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:
97058-3612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-980-5497
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2024