Provider First Line Business Practice Location Address:
4005 AUMSVILLE HWY 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:
97317-9112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-378-2144
Provider Business Practice Location Address Fax Number:
503-378-2184
Provider Enumeration Date:
08/16/2010