Provider First Line Business Practice Location Address:
648 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97520-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-482-8100
Provider Business Practice Location Address Fax Number:
541-488-5081
Provider Enumeration Date:
06/17/2005