Provider First Line Business Practice Location Address:
240 LUTHER ST S
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:
97302-5217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-361-7797
Provider Business Practice Location Address Fax Number:
503-361-7713
Provider Enumeration Date:
11/28/2005