Provider First Line Business Practice Location Address:
415 WASHINGTON 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:
97058-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-296-2911
Provider Business Practice Location Address Fax Number:
541-296-2224
Provider Enumeration Date:
09/15/2005