Provider First Line Business Practice Location Address:
330 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-474-7446
Provider Business Practice Location Address Fax Number:
866-454-3484
Provider Enumeration Date:
03/07/2008