Provider First Line Business Practice Location Address:
PENINSULA FAMILY DENTISTRY PLC
Provider Second Line Business Practice Location Address:
12610 PATRICK HENRY DRIVE SUITE G
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-874-8612
Provider Business Practice Location Address Fax Number:
757-578-9117
Provider Enumeration Date:
12/18/2006