Provider First Line Business Practice Location Address:
2250 COMMERCIAL ST NE
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:
97303-6616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-581-7590
Provider Business Practice Location Address Fax Number:
503-581-6641
Provider Enumeration Date:
01/26/2007