Provider First Line Business Practice Location Address: 
2655 MARTIN LUTHER KING JR BLVD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
EUGENE
    Provider Business Practice Location Address State Name: 
OR
    Provider Business Practice Location Address Postal Code: 
97401
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
541-682-7979
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
03/14/2013