Provider First Line Business Practice Location Address:
3545 LANCASTER DR 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:
97305-1435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-672-2747
Provider Business Practice Location Address Fax Number:
541-672-2757
Provider Enumeration Date:
02/14/2013