Provider First Line Business Practice Location Address:
117 NW 8TH STREET
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
MCMINNVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-974-0997
Provider Business Practice Location Address Fax Number:
503-716-4632
Provider Enumeration Date:
09/14/2010