Provider First Line Business Practice Location Address:
4102 ORANGE AVE
Provider Second Line Business Practice Location Address:
STE 120 DABALUS SAULOG FAMILY DENTISTRY INC
Provider Business Practice Location Address City Name:
LONG BCH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-989-9652
Provider Business Practice Location Address Fax Number:
562-988-0445
Provider Enumeration Date:
05/07/2007