Provider First Line Business Practice Location Address:
228 NE 3RD 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:
97128-4819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-472-2147
Provider Business Practice Location Address Fax Number:
503-437-9206
Provider Enumeration Date:
08/07/2006