Provider First Line Business Practice Location Address:
1828 WEST LAKE AVENUE
Provider Second Line Business Practice Location Address:
DENTAL CLINIC
Provider Business Practice Location Address City Name:
NEPTUNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-869-5736
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2010