Provider First Line Business Practice Location Address:
121 HIGHWAY 36
Provider Second Line Business Practice Location Address:
#100 IMMEDIATE DENTAL PC
Provider Business Practice Location Address City Name:
WEST LONG BRANCH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-222-8516
Provider Business Practice Location Address Fax Number:
732-222-1149
Provider Enumeration Date:
05/03/2007