Provider First Line Business Practice Location Address:
1060 WEBBER 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:
97058-3749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-296-5452
Provider Business Practice Location Address Fax Number:
541-296-1537
Provider Enumeration Date:
05/03/2021