Provider First Line Business Practice Location Address:
374 OWENS ST SE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97302-4183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-399-1400
Provider Business Practice Location Address Fax Number:
503-399-1406
Provider Enumeration Date:
06/13/2007