Provider First Line Business Practice Location Address: 
1601 SW JEFFERSON STREET
    Provider Second Line Business Practice Location Address: 
OREGON STATE UNIVERSITY - COLLEGE OF PHARMACY
    Provider Business Practice Location Address City Name: 
CORVALLIS
    Provider Business Practice Location Address State Name: 
OR
    Provider Business Practice Location Address Postal Code: 
97331-3507
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
541-737-5785
    Provider Business Practice Location Address Fax Number: 
541-737-3999
    Provider Enumeration Date: 
10/18/2010