Provider First Line Business Practice Location Address:
2504 NW MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97470-5510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-957-0111
Provider Business Practice Location Address Fax Number:
541-957-0333
Provider Enumeration Date:
10/25/2005