Provider First Line Business Practice Location Address:
400 W HERSEY ST
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97520-1839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-488-1665
Provider Business Practice Location Address Fax Number:
541-552-1009
Provider Enumeration Date:
03/02/2007