Provider First Line Business Practice Location Address:
380 JERRIS AVE 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:
97302-5278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-315-2222
Provider Business Practice Location Address Fax Number:
503-315-2248
Provider Enumeration Date:
10/09/2007