Provider First Line Business Practice Location Address:
GREAT LAKES DENTAL SERVICES, PC
Provider Second Line Business Practice Location Address:
107 E CHESTNUT ST
Provider Business Practice Location Address City Name:
ROME
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-336-0494
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2007