Provider First Line Business Practice Location Address:
DENTAL SOUTH P A
Provider Second Line Business Practice Location Address:
800 MARIE AVENUE
Provider Business Practice Location Address City Name:
SOUTH ST PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-451-1277
Provider Business Practice Location Address Fax Number:
651-455-8488
Provider Enumeration Date:
05/09/2007