Provider First Line Business Practice Location Address:
VANCHCS OUTPATIENT CLINIC. DENTAL SERVICE (160/MI)
Provider Second Line Business Practice Location Address:
BLDG. 201, WALNUT AVE.
Provider Business Practice Location Address City Name:
MARE ISLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-562-8294
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2006