Provider First Line Business Practice Location Address:
201 NW MEDICAL LOOP STE 190
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97471-8835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-644-4319
Provider Business Practice Location Address Fax Number:
541-677-2294
Provider Enumeration Date:
12/31/2008