Provider First Line Business Practice Location Address:
3400 BROWNS CREEK RD
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:
97058-7528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-471-0786
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2011