Provider First Line Business Practice Location Address:
1840 NEWBERG HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBURN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97071-3187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-982-2005
Provider Business Practice Location Address Fax Number:
503-982-2561
Provider Enumeration Date:
12/28/2009