Provider First Line Business Practice Location Address:
501 PORTWAY AVENUE
Provider Second Line Business Practice Location Address:
202
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:
541-436-2740
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2005