Provider First Line Business Practice Location Address:
317 E 2ND 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:
97058-2107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-296-5878
Provider Business Practice Location Address Fax Number:
541-296-3434
Provider Enumeration Date:
02/01/2007