Provider First Line Business Practice Location Address:
502 WASHINGTON ST STE 210
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:
97058-2270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-398-1085
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2009