Provider First Line Business Practice Location Address:
485 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97520-2162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-488-1479
Provider Business Practice Location Address Fax Number:
541-488-1679
Provider Enumeration Date:
01/29/2009