Provider First Line Business Practice Location Address:
2973 12TH STREET 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:
97302-6162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-561-7100
Provider Business Practice Location Address Fax Number:
503-561-7124
Provider Enumeration Date:
12/12/2006