Provider First Line Business Practice Location Address:
1060 GAFFNEY ROAD #7500
Provider Second Line Business Practice Location Address:
USA DENTAC
Provider Business Practice Location Address City Name:
FORT WAINWRIGHT
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-361-5530
Provider Business Practice Location Address Fax Number:
907-361-4859
Provider Enumeration Date:
08/18/2006