Provider First Line Business Practice Location Address:
925 COMMERCIAL ST SE
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-391-2848
Provider Business Practice Location Address Fax Number:
503-391-0402
Provider Enumeration Date:
12/19/2006