Provider First Line Business Practice Location Address:
6902 SE LAKE RD
Provider Second Line Business Practice Location Address:
WILLAMETTE DENTAL GROUP
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-461-8994
Provider Business Practice Location Address Fax Number:
360-750-9789
Provider Enumeration Date:
03/03/2010