Provider First Line Business Practice Location Address:
609, BEAVER RUIN ROAD
Provider Second Line Business Practice Location Address:
TEBO DENTAL FOR KIDS
Provider Business Practice Location Address City Name:
LILBURN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-925-3300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2015