Provider First Line Business Practice Location Address:
1100 N. COLLEGE AVE
Provider Second Line Business Practice Location Address:
BUILDING 21, DENTAL CLINIC
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-444-5042
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2009