Provider First Line Business Practice Location Address:
417 SHERMAN AVE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
HOOD RIVER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97031-2076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-386-5505
Provider Business Practice Location Address Fax Number:
541-386-5506
Provider Enumeration Date:
07/02/2008