Provider First Line Business Practice Location Address:
857 MEDICAL CENTER DR NE
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:
97301-2752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-375-0555
Provider Business Practice Location Address Fax Number:
503-375-3380
Provider Enumeration Date:
11/29/2005