Provider First Line Business Practice Location Address:
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST, MT, TAL
Provider Second Line Business Practice Location Address:
10100 SE SUNNYSIDE ROAD
Provider Business Practice Location Address City Name:
CLACKAMAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97015-9764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-571-3711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2006