BRODERICK R STATES

MEDFORD, OR
NPI1073178794
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YM0800X Counselor, Mental Health
Enumeration Date2019-05-08
Last Update Date2019-05-08
Business Address
BRODERICK R STATES
3200 JUANIPERO WAY
MEDFORD, OR 97504
Phone number: 541-816-4131
Mailing Address
BRODERICK R STATES
3587 HEATHROW WAY
MEDFORD, OR 97504-4004
Phone number: 541-858-8170
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