Provider First Line Business Practice Location Address:
1918 E MCKELLIPS
Provider Second Line Business Practice Location Address:
THUNDERBIRD DENTAL GROUP
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85203-2866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-835-7357
Provider Business Practice Location Address Fax Number:
480-649-6088
Provider Enumeration Date:
12/13/2006