Provider First Line Business Practice Location Address:
420 NE 5TH ST
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:
97128-4603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-662-4233
Provider Business Practice Location Address Fax Number:
503-434-7335
Provider Enumeration Date:
12/10/2012