Provider First Line Business Practice Location Address:
325 NE 6TH 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:
97128-4702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-472-6182
Provider Business Practice Location Address Fax Number:
503-472-8366
Provider Enumeration Date:
09/20/2006