Provider First Line Business Practice Location Address:
240 E HERSEY ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97520-5202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-488-0600
Provider Business Practice Location Address Fax Number:
541-482-2119
Provider Enumeration Date:
04/27/2016