Provider First Line Business Practice Location Address:
2510 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:
541-673-4152
Provider Business Practice Location Address Fax Number:
541-673-4156
Provider Enumeration Date:
05/29/2008