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1003392515
ALAN KEITH GUSTAFSON
SALEM, OR
NPI
1003392515
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
172V00000X Community Health Worker
Enumeration Date
2018-07-17
Last Update Date
2018-07-17
Business Address
ALAN KEITH GUSTAFSON
4890 32ND AVE SE
SALEM, OR 97317-9350
Phone number: 503-588-5647
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Mailing Address
ALAN KEITH GUSTAFSON
4890 32ND AVE SE
SALEM, OR 97317-9350
Phone number: 503-588-5647
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