Provider First Line Business Practice Location Address:
2450 12TH 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-371-4350
Provider Business Practice Location Address Fax Number:
503-371-1124
Provider Enumeration Date:
05/18/2009