Provider First Line Business Practice Location Address:
2025 NE BAKER ST STE A
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:
97128-2656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-844-6565
Provider Business Practice Location Address Fax Number:
503-844-4225
Provider Enumeration Date:
07/26/2013