Provider First Line Business Practice Location Address:
2600 CENTER STREET NE (OFFICE GO5-216)
Provider Second Line Business Practice Location Address:
OREGON STATE HOSPITAL, FORENSIC EVALUATION SERVICE
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97301-2669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-945-9281
Provider Business Practice Location Address Fax Number:
503-945-9747
Provider Enumeration Date:
10/15/2012