Provider First Line Business Practice Location Address:
3200 SOUTH UNIVERSITY DRIVE
Provider Second Line Business Practice Location Address:
NSU COLLEGE OF DENTAL MEDICINE DEPT OF PERIODONTOLOGY
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-262-7330
Provider Business Practice Location Address Fax Number:
954-262-1782
Provider Enumeration Date:
11/28/2005