Provider First Line Business Practice Location Address:
26636 MARGARITA RD STE 102
Provider Second Line Business Practice Location Address:
C/O DATEDENTAL.COM
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92563-2010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-600-0858
Provider Business Practice Location Address Fax Number:
950-600-2623
Provider Enumeration Date:
12/03/2010