Provider First Line Business Practice Location Address:
207 W 3RD ST
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:
97058-1734
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:
541-296-2731
Provider Enumeration Date:
08/28/2015