Provider First Line Business Practice Location Address:
900 SE BAKER ST
Provider Second Line Business Practice Location Address:
LINFIELD COLLEGE, UNIT A458
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:
503-883-2417
Provider Business Practice Location Address Fax Number:
503-883-2453
Provider Enumeration Date:
06/07/2006