Provider First Line Business Practice Location Address:
1290 23RD 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:
97301-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-966-2382
Provider Business Practice Location Address Fax Number:
503-386-3301
Provider Enumeration Date:
06/16/2021