Provider First Line Business Practice Location Address:
440 FAIR DR
Provider Second Line Business Practice Location Address:
STE R SHAH & SHAH DENTAL PRACTICE
Provider Business Practice Location Address City Name:
COSTA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-751-6856
Provider Business Practice Location Address Fax Number:
714-781-6663
Provider Enumeration Date:
11/14/2006