Provider First Line Business Practice Location Address:
10102 NE GLISAN AVE
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE GLISAN DENTAL OFFICE
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-257-5959
Provider Business Practice Location Address Fax Number:
503-408-1472
Provider Enumeration Date:
03/28/2007