Provider First Line Business Practice Location Address: 
1232 UNIVERSITY OF OREGON
    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: 
97403-1205
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
541-346-4447
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/16/2009