Provider First Line Business Practice Location Address:
23RD DENTAL COMPANY
Provider Second Line Business Practice Location Address:
1591 GRIFFIN ROAD
Provider Business Practice Location Address City Name:
TWENTYNINE PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-221-8386
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2019