Individual
TERESA ODEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
307 SW G ST, GRANTS PASS, OR 97526-2417
(541) 476-8094
Mailing address
307 SW G ST, GRANTS PASS, OR 97526-2417
(541) 476-8094
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
716051-91
OR
Other
Enumeration date
07/09/2014
Last updated
07/09/2014
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