Provider First Line Business Practice Location Address:
401 E 3RD ST STE 101
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:
97058-2563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-298-2101
Provider Business Practice Location Address Fax Number:
541-298-7996
Provider Enumeration Date:
11/01/2006