Provider First Line Business Practice Location Address:
301 SE 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANTS PASS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97526-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-476-4464
Provider Business Practice Location Address Fax Number:
541-476-4222
Provider Enumeration Date:
03/23/2006