Provider First Line Business Practice Location Address:
2080 NE HWY 99 W
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:
503-472-2445
Provider Business Practice Location Address Fax Number:
541-764-3852
Provider Enumeration Date:
07/11/2005