Provider First Line Business Practice Location Address:
78461 HIGHWAY 111
Provider Second Line Business Practice Location Address:
PLAZA DENTAL GROUP
Provider Business Practice Location Address City Name:
LA QUINTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92253-2076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-564-5455
Provider Business Practice Location Address Fax Number:
760-564-3874
Provider Enumeration Date:
11/22/2006