Provider First Line Business Practice Location Address:
1801 HIGHWAY 99 N
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97520-9152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-482-6867
Provider Business Practice Location Address Fax Number:
541-482-7462
Provider Enumeration Date:
01/16/2006