Provider First Line Business Practice Location Address:
6101 CANDELARIA NE
Provider Second Line Business Practice Location Address:
PERFECT TEETH
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-883-0005
Provider Business Practice Location Address Fax Number:
505-881-4487
Provider Enumeration Date:
08/02/2005