Provider First Line Business Practice Location Address:
10707 W BELOIT RD
Provider Second Line Business Practice Location Address:
ADVANCED DENTAL TREATMENT CENTER
Provider Business Practice Location Address City Name:
GREEN FIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-258-9630
Provider Business Practice Location Address Fax Number:
414-258-1955
Provider Enumeration Date:
09/01/2006