Provider First Line Business Practice Location Address:
2115 E EVERGREEN DR
Provider Second Line Business Practice Location Address:
DENTAL ASSOCIATES, LTD
Provider Business Practice Location Address City Name:
APPLETON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-734-2345
Provider Business Practice Location Address Fax Number:
920-734-5651
Provider Enumeration Date:
04/05/2006