Provider First Line Business Practice Location Address:
1103 WALNUT DRIVE
Provider Second Line Business Practice Location Address:
PEDIATRIC DENTAL ASSOCIATES PC
Provider Business Practice Location Address City Name:
ARDMORE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-226-6290
Provider Business Practice Location Address Fax Number:
580-223-4381
Provider Enumeration Date:
12/01/2006