Provider First Line Business Practice Location Address:
965 LIBERTY STREET SE
Provider Second Line Business Practice Location Address:
POYAMA COUNSELING
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-588-2004
Provider Business Practice Location Address Fax Number:
503-588-2415
Provider Enumeration Date:
03/06/2007