Provider First Line Business Practice Location Address:
208 E 4TH 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:
97058-2206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-298-2904
Provider Business Practice Location Address Fax Number:
541-296-8235
Provider Enumeration Date:
01/25/2007