Provider First Line Business Practice Location Address:
419 E 7TH ST STE 207
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:
97058-2676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-296-5452
Provider Business Practice Location Address Fax Number:
541-296-1537
Provider Enumeration Date:
10/23/2017