Provider First Line Business Practice Location Address:
1927 NE 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:
97128-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-472-2222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2008