Provider First Line Business Practice Location Address:
414 WASHINGTON ST
Provider Second Line Business Practice Location Address:
2B
Provider Business Practice Location Address City Name:
THE DALLES
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97058-2262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-993-2847
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2007