Provider First Line Business Practice Location Address:
419 STATE ST
Provider Second Line Business Practice Location Address:
STE 4
Provider Business Practice Location Address City Name:
HOOD RIVER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97031-2075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-387-8688
Provider Business Practice Location Address Fax Number:
541-387-6785
Provider Enumeration Date:
06/01/2005