Provider First Line Business Practice Location Address:
1625 COMMERCIAL ST SE
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:
97302-4311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-858-8420
Provider Business Practice Location Address Fax Number:
503-581-3897
Provider Enumeration Date:
01/18/2007