Provider First Line Business Practice Location Address:
389 CONGRESS ST.
Provider Second Line Business Practice Location Address:
HEALTH AND HUMAN SERVICES, CHILDREN'S ORAL HEALTH
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-541-6632
Provider Business Practice Location Address Fax Number:
207-541-6891
Provider Enumeration Date:
02/06/2007