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1124752233
GRACE LAKE
NEWPORT, OR
NPI
1124752233
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: OR PA221993)
Enumeration Date
2022-07-13
Last Update Date
2024-11-08
Business Address
GRACE LAKE
930 SW ABBEY ST
NEWPORT, OR 97365-4820
Phone number: 541-265-2244
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Mailing Address
GRACE LAKE
930 SW ABBEY ST
NEWPORT, OR 97365-4820
Phone number:
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