Provider First Line Business Practice Location Address:
900 STATE ST
Provider Second Line Business Practice Location Address:
EXERCISE SCIENCE - SPORTS MEDICINE
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97301-3922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-370-6470
Provider Business Practice Location Address Fax Number:
503-370-6379
Provider Enumeration Date:
04/11/2006