Provider First Line Business Practice Location Address:
223 SE M ST
Provider Second Line Business Practice Location Address:
HAMILTON HOUSE ANNEX
Provider Business Practice Location Address City Name:
GRANTS PASS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97526-3133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-955-9565
Provider Business Practice Location Address Fax Number:
541-955-8290
Provider Enumeration Date:
10/23/2006