Provider First Line Business Practice Location Address:
540 S MAIN ST
Provider Second Line Business Practice Location Address:
PROVIDENCE BENEDICTINE REHAB DPT
Provider Business Practice Location Address City Name:
MOUNT ANGEL
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97362-9540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-845-2736
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2007