Provider First Line Business Practice Location Address: 
640 S. 2ND STREET
    Provider Second Line Business Practice Location Address: 
FAMILY SOLUTIONS
    Provider Business Practice Location Address City Name: 
CENTRAL POINT
    Provider Business Practice Location Address State Name: 
OR
    Provider Business Practice Location Address Postal Code: 
97502
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
541-665-0359
    Provider Business Practice Location Address Fax Number: 
541-665-0358
    Provider Enumeration Date: 
07/28/2014