Provider First Line Business Practice Location Address:
1201 NE 7TH ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
GRANTS PASS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97526-1451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-474-4360
Provider Business Practice Location Address Fax Number:
541-474-0685
Provider Enumeration Date:
07/07/2009