Provider First Line Business Practice Location Address:
16289 HIGHWAY 101 S STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKINGS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97415-8404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-200-7302
Provider Business Practice Location Address Fax Number:
541-254-9002
Provider Enumeration Date:
04/03/2026