Provider First Line Business Practice Location Address:
1625 E 12TH 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:
97058-3212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-298-6910
Provider Business Practice Location Address Fax Number:
541-298-6912
Provider Enumeration Date:
02/06/2007