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1083279640
CHARLES KEITH SANBORN
PRINEVILLE, OR
NPI
1083279640
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OR 500654390)
Enumeration Date
2019-05-08
Last Update Date
2019-05-08
Business Address
CHARLES KEITH SANBORN
357 NE COURT ST
PRINEVILLE, OR 97754-1936
Phone number: 541-504-7535
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Mailing Address
CHARLES KEITH SANBORN
357 NE COURT ST
PRINEVILLE, OR 97754-1936
Phone number: 541-504-7535
Copy
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