Provider First Line Business Practice Location Address:
OSU-SHS 108 SW MEMORIAL PLACE
Provider Second Line Business Practice Location Address:
201 PLAGEMAN BUILDING
Provider Business Practice Location Address City Name:
CORVALLIS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97331-5801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-737-9355
Provider Business Practice Location Address Fax Number:
541-737-9694
Provider Enumeration Date:
10/12/2007