Provider First Line Business Practice Location Address:
2373 KUEBLER RD. 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-399-3261
Provider Business Practice Location Address Fax Number:
503-391-4046
Provider Enumeration Date:
11/14/2016