Provider First Line Business Practice Location Address:
6140 MILL CREEK RD
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:
97058-8505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-705-5255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2014