Provider First Line Business Practice Location Address:
3001 GREEN BAY ROAD
Provider Second Line Business Practice Location Address:
BUILDING 237, FISHER DENTAL CLINIC
Provider Business Practice Location Address City Name:
NORTH CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60064-3048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-5578
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2009