Provider First Line Business Practice Location Address:
1309 LIBERTY 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:
97302-4245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-585-2025
Provider Business Practice Location Address Fax Number:
503-304-2222
Provider Enumeration Date:
08/21/2006