Provider First Line Business Practice Location Address:
618TH DENTAL COMPANY AS
Provider Second Line Business Practice Location Address:
UNIT 15652 DENTAL CLINIC 3
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96205-0652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
01182279165221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2006