Provider First Line Business Practice Location Address:
7802 N 43RD AVE STE 8
Provider Second Line Business Practice Location Address:
BAPTIST DENTAL CENTER
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85301-8111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-939-6215
Provider Business Practice Location Address Fax Number:
623-915-0654
Provider Enumeration Date:
11/02/2005