Provider First Line Business Practice Location Address:
253 NE FRONT ST
Provider Second Line Business Practice Location Address:
MILFORD STATE SERVICE CENTER AT RIVERWALK DENTAL CLINIC
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19963-1431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-424-7160
Provider Business Practice Location Address Fax Number:
302-424-7203
Provider Enumeration Date:
12/23/2005