Provider First Line Business Practice Location Address:
1020 LIBERTY 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:
97302-4141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-581-7412
Provider Business Practice Location Address Fax Number:
503-581-1095
Provider Enumeration Date:
10/12/2006