Provider First Line Business Practice Location Address:
1515 NW 9TH ST
Provider Second Line Business Practice Location Address:
C/O NORTHWEST HEALTH AND HEALING CENTER
Provider Business Practice Location Address City Name:
CORVALLIS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97330-4512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-754-2225
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2011