Provider First Line Business Practice Location Address:
3016 NORTH KENTWOOD
Provider Second Line Business Practice Location Address:
SPRINGFIELD DENTURE CENTER
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65803-4414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-833-1474
Provider Business Practice Location Address Fax Number:
417-833-1243
Provider Enumeration Date:
02/21/2007