Provider First Line Business Practice Location Address:
12570 BROOKHURST STREET
Provider Second Line Business Practice Location Address:
SUITE # 2 PRIMARY DENTAL CARE
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-537-5700
Provider Business Practice Location Address Fax Number:
714-537-5701
Provider Enumeration Date:
09/27/2006