Provider First Line Business Practice Location Address:
1801 HIGHWAY 99 N
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97520-9152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-482-5515
Provider Business Practice Location Address Fax Number:
541-482-2433
Provider Enumeration Date:
03/17/2010