Provider First Line Business Practice Location Address:
108 SW MEMORIAL PLACE
Provider Second Line Business Practice Location Address:
201 PLAGEMAN BUILDING,OSU STUDENT HEALTH SERVICES
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:
541-737-7565
Provider Business Practice Location Address Fax Number:
541-737-9694
Provider Enumeration Date:
04/20/2007