Provider First Line Business Practice Location Address:
13624 HAWTHORNE BLVD
Provider Second Line Business Practice Location Address:
SUITE 205 SUNRISE DENTAL GROUP
Provider Business Practice Location Address City Name:
HAWTHORNE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-856-6574
Provider Business Practice Location Address Fax Number:
310-856-6578
Provider Enumeration Date:
01/05/2007