Provider First Line Business Practice Location Address:
375 DENTAL SQUADRON
Provider Second Line Business Practice Location Address:
310 W. LOSEY ST.
Provider Business Practice Location Address City Name:
DENTAL SQUADRON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
62225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-256-2750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2005