PHILIP BROESAMLE

SHADY COVE, OR
NPI1427444264
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2015-04-08
Last Update Date2015-04-08
Business Address
-- PHILIP BROESAMLE
60 MALLORY LN.
SHADY COVE, OR 97539
Phone number: 541-878-2658
Mailing Address
-- PHILIP BROESAMLE
PO BOX 323
SHADY COVE, OR 97539
Phone number: