Provider First Line Business Practice Location Address:
913 NW GARDEN VALLY BLVD
Provider Second Line Business Practice Location Address:
ROSEBURG VA HEALTHCARE SYSTEM
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-440-1377
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2005