Provider First Line Business Practice Location Address:
207 NE 19TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCMINNVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97128-9927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-883-4445
Provider Business Practice Location Address Fax Number:
503-883-5831
Provider Enumeration Date:
01/08/2009