Provider First Line Business Practice Location Address:
6517 TAFT ST STE 201
Provider Second Line Business Practice Location Address:
PRIMARY DENTAL CARE
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33024-4063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-399-7839
Provider Business Practice Location Address Fax Number:
954-212-5718
Provider Enumeration Date:
10/02/2013