Provider First Line Business Practice Location Address:
2605 STATE STREET
Provider Second Line Business Practice Location Address:
OREGON STATE PENITENTIARY
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-745-5549
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2006