Provider First Line Business Practice Location Address:
110 W ENT AVE
Provider Second Line Business Practice Location Address:
21ST DENTAL SQUADRON
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80914-1595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-556-1334
Provider Business Practice Location Address Fax Number:
719-556-1331
Provider Enumeration Date:
02/02/2006