Provider First Line Business Practice Location Address:
900 SE BAKER ST
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:
97128-6808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-883-2580
Provider Business Practice Location Address Fax Number:
503-883-2453
Provider Enumeration Date:
05/27/2006