Provider First Line Business Practice Location Address:
962 1ST INFANTRY DIVISION RD
Provider Second Line Business Practice Location Address:
JORDAN DENTAL CLINIC BLDG 2724
Provider Business Practice Location Address City Name:
FORT KNOX
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40121-5210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-626-8301
Provider Business Practice Location Address Fax Number:
502-626-8300
Provider Enumeration Date:
08/25/2016