Provider First Line Business Practice Location Address:
3301 COLLEGE AVENUE / COLLEGE OF DENTAL MEDICINE
Provider Second Line Business Practice Location Address:
NOVA SOUTHEASTERN UNIVERSITY COLLEGE OF DENTAL MEDICINE
Provider Business Practice Location Address City Name:
FT. LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33314-7796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-541-6682
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2006