Provider First Line Business Practice Location Address:
6496 N PIQUA RD
Provider Second Line Business Practice Location Address:
DECATUR DENTAL SERVICES INC
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-724-8746
Provider Business Practice Location Address Fax Number:
260-724-2175
Provider Enumeration Date:
11/21/2006