Provider First Line Business Practice Location Address:
139 N 2ND 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:
97520-1934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-488-8248
Provider Business Practice Location Address Fax Number:
541-488-8248
Provider Enumeration Date:
04/26/2007