Graduated: 2014
NPI: 1942639323
Practice Locations (3)
500 E WHITEAKER AVE
COTTAGE GROVE, OR 974241648
5412700434
PO BOX, SUITE 1025
COTTAGE GROVE, OR 974240045
175 W B ST, BLDG K
SPRINGFIELD, OR 974774575
Source: CMS National Downloadable File, September 2026.