Provider First Line Business Practice Location Address:
COASTAL CENTER, LLC
Provider Second Line Business Practice Location Address:
1834 MCPHERSON AVE
Provider Business Practice Location Address City Name:
NORTH BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-267-2113
Provider Business Practice Location Address Fax Number:
541-267-5071
Provider Enumeration Date:
12/11/2006