Provider First Line Business Practice Location Address:
851 NE BAKER ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
MCMINNVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97128-4991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-434-5222
Provider Business Practice Location Address Fax Number:
877-878-1984
Provider Enumeration Date:
02/07/2008