Provider First Line Business Practice Location Address:
12426 S. VAN DYKE RD SUITE B
Provider Second Line Business Practice Location Address:
HERITAGE GROVE FAMILY DENTAL
Provider Business Practice Location Address City Name:
PLAINFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-254-6700
Provider Business Practice Location Address Fax Number:
815-254-5995
Provider Enumeration Date:
09/21/2006