Provider First Line Business Practice Location Address:
514 STATE ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOOD RIVER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97031-2074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-436-3880
Provider Business Practice Location Address Fax Number:
541-436-3881
Provider Enumeration Date:
09/27/2006