Provider First Line Business Practice Location Address:
1233 EDGEWATER ST. NW
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:
97304-3293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-378-7529
Provider Business Practice Location Address Fax Number:
503-480-1611
Provider Enumeration Date:
08/08/2023