Provider First Line Business Practice Location Address:
123 SE DOUGLAS STREET
Provider Second Line Business Practice Location Address:
FAMILY DENTAL,
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-265-4221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/10/2014