Provider First Line Business Practice Location Address:
618TH DENTAL COMPANY (AS)
Provider Second Line Business Practice Location Address:
UNIT 15660, BX 123
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-512-2388
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2005