Provider First Line Business Practice Location Address:
1919 GARRISON 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:
97058-1619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-980-8375
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2013