Provider First Line Business Practice Location Address:
212 WASHINGTON 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:
97058-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-645-2749
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/23/2020