Provider First Line Business Practice Location Address:
23823 EL TORO RD. SUTE E-122
Provider Second Line Business Practice Location Address:
EL TORO DENTAL CARE
Provider Business Practice Location Address City Name:
LAKE FOREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-855-9212
Provider Business Practice Location Address Fax Number:
949-855-9272
Provider Enumeration Date:
11/14/2013