Provider First Line Business Practice Location Address:
1700 12TH ST STE C
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:
97031-9540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-254-6161
Provider Business Practice Location Address Fax Number:
360-449-1146
Provider Enumeration Date:
01/20/2006