Provider First Line Business Practice Location Address:
608 E 2ND 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:
97058-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-298-5558
Provider Business Practice Location Address Fax Number:
541-298-5559
Provider Enumeration Date:
08/26/2008