Provider First Line Business Practice Location Address:
860 EAST HIGHWAY 114 IDEAL DENTAL
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-491-3000
Provider Business Practice Location Address Fax Number:
214-291-9582
Provider Enumeration Date:
07/07/2015