Provider First Line Business Practice Location Address:
13975 MONO WAY SUITE I
Provider Second Line Business Practice Location Address:
MACT INDIAN DENTAL CLINIC
Provider Business Practice Location Address City Name:
SONORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95370-2824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-533-9603
Provider Business Practice Location Address Fax Number:
209-533-9604
Provider Enumeration Date:
07/20/2006