Provider First Line Business Practice Location Address:
810 13TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOOD RIVER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97031-1210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-387-6464
Provider Business Practice Location Address Fax Number:
541-386-9322
Provider Enumeration Date:
09/18/2007