Provider First Line Business Practice Location Address:
818 W 6TH ST STE 1
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:
97058-1147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-296-0006
Provider Business Practice Location Address Fax Number:
541-296-4251
Provider Enumeration Date:
01/13/2015