Provider First Line Business Practice Location Address:
266 EAST 49TH STREET
Provider Second Line Business Practice Location Address:
HIALEAH DENTAL BUILDING
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33013-1855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-823-9982
Provider Business Practice Location Address Fax Number:
305-821-4478
Provider Enumeration Date:
08/10/2006