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1073178794
BRODERICK R STATES
MEDFORD, OR
NPI
1073178794
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2019-05-08
Last Update Date
2019-05-08
Business Address
BRODERICK R STATES
3200 JUANIPERO WAY
MEDFORD, OR 97504
Phone number: 541-816-4131
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Mailing Address
BRODERICK R STATES
3587 HEATHROW WAY
MEDFORD, OR 97504-4004
Phone number: 541-858-8170
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