Provider First Line Business Practice Location Address:
425 SW 26TH ST
Provider Second Line Business Practice Location Address:
OREGON STATE UNIVERSITY - DIXON RECREATION CENTER
Provider Business Practice Location Address City Name:
CORVALLIS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97331
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:
541-737-7721
Provider Enumeration Date:
01/07/2009