Provider First Line Business Practice Location Address:
848 COMMERCIAL ST 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:
97301-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-362-9151
Provider Business Practice Location Address Fax Number:
503-362-9184
Provider Enumeration Date:
08/24/2005