Provider First Line Business Practice Location Address:
419 E 7TH ST
Provider Second Line Business Practice Location Address:
STE. 207
Provider Business Practice Location Address City Name:
THE DALLES
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97058-2676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-490-4377
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2014