Provider First Line Business Practice Location Address:
1115 BARNES AVE 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:
97306-1541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-797-9977
Provider Business Practice Location Address Fax Number:
626-844-2977
Provider Enumeration Date:
03/26/2015