Provider First Line Business Practice Location Address:
410 N MALACATE ST BLDG B
Provider Second Line Business Practice Location Address:
DESERT SENITA DENTAL CENTER
Provider Business Practice Location Address City Name:
AJO
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85321-2254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-387-4500
Provider Business Practice Location Address Fax Number:
520-387-3509
Provider Enumeration Date:
07/17/2006