Provider First Line Business Practice Location Address:
310 SOUTHEAST BAKER STREET
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:
97128-6038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-472-8433
Provider Business Practice Location Address Fax Number:
503-472-8679
Provider Enumeration Date:
08/21/2006