Provider First Line Business Practice Location Address:
1302 N HIGHWAY 99 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCMINNVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97128-9999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-472-5665
Provider Business Practice Location Address Fax Number:
503-474-1585
Provider Enumeration Date:
11/29/2006