Provider First Line Business Practice Location Address:
1940 12TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOOD RIVER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-386-4844
Provider Business Practice Location Address Fax Number:
541-386-7237
Provider Enumeration Date:
11/01/2006