Provider First Line Business Practice Location Address:
1015 WEBBER 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:
97058-3527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-967-3070
Provider Business Practice Location Address Fax Number:
858-431-4736
Provider Enumeration Date:
10/20/2025