Individual
JUSTIN LEE MAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
3325 HAROLD DR NE, SALEM, OR 97305-1339
(503) 363-2021
Mailing address
PO BOX 17818, SALEM, OR 97305-7818
(503) 363-2021
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
17-CRM-198
OR
Other
Enumeration date
02/14/2018
Last updated
02/14/2018
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