Provider First Line Business Practice Location Address:
1813 W. HARVARD AVE
Provider Second Line Business Practice Location Address:
STE 212
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-229-4530
Provider Business Practice Location Address Fax Number:
541-229-4532
Provider Enumeration Date:
02/27/2008