Provider First Line Business Practice Location Address:
1006 FOREST AVE
Provider Second Line Business Practice Location Address:
PORTLAND FAMILY DENTAL
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04103-3343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-797-3585
Provider Business Practice Location Address Fax Number:
207-797-3592
Provider Enumeration Date:
03/05/2007