Provider First Line Business Practice Location Address:
400 W HERSEY ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97520-1864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-482-7047
Provider Business Practice Location Address Fax Number:
541-552-1009
Provider Enumeration Date:
10/17/2011