Provider First Line Business Practice Location Address: 
PEACEHEALTH HOSPITAL MEDICINE
    Provider Second Line Business Practice Location Address: 
3377 RIVERBEND DRIVE
    Provider Business Practice Location Address City Name: 
SPRINGFIELD
    Provider Business Practice Location Address State Name: 
OR
    Provider Business Practice Location Address Postal Code: 
97477-8803
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
541-222-6389
    Provider Business Practice Location Address Fax Number: 
541-222-6385
    Provider Enumeration Date: 
02/10/2006