Provider First Line Business Practice Location Address:
2508 PRINGLE RD 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:
97302-1532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-585-4027
Provider Business Practice Location Address Fax Number:
503-585-4741
Provider Enumeration Date:
08/27/2007