Provider First Line Business Practice Location Address:
800 W 6TH ST STE 3
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:
97058-1146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-769-1002
Provider Business Practice Location Address Fax Number:
541-769-1008
Provider Enumeration Date:
02/14/2020