Provider First Line Business Practice Location Address:
1220 20TH ST SE STE 310
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:
97302-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-954-2197
Provider Business Practice Location Address Fax Number:
503-954-2198
Provider Enumeration Date:
09/03/2008