Provider First Line Business Practice Location Address:
1105 W PARK AVE SUITE 8
Provider Second Line Business Practice Location Address:
PARK DENTAL
Provider Business Practice Location Address City Name:
LIBERTYVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-362-4740
Provider Business Practice Location Address Fax Number:
847-362-4764
Provider Enumeration Date:
09/14/2006