Provider First Line Business Practice Location Address:
UNIT 26610
Provider Second Line Business Practice Location Address:
WUERBERG DENTAL ACTIVITY CREDENTIALS OFFICE
Provider Business Practice Location Address City Name:
APO AE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
09244-6610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-300-1720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2006