Provider First Line Business Practice Location Address:
1900 NE HIGHWAY 99W STE K
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:
97128-2757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-472-4511
Provider Business Practice Location Address Fax Number:
503-714-6306
Provider Enumeration Date:
10/30/2019