Provider First Line Business Practice Location Address:
JOEL DENTAL CLINIC BLDG M4861 LOGISTICS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LIBERTY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28310-5460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-871-7308
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2010