Provider First Line Business Practice Location Address:
1875 HIGHWAY 99 N STE D
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:
97520-9120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-488-8988
Provider Business Practice Location Address Fax Number:
541-488-7977
Provider Enumeration Date:
01/17/2007