Provider First Line Business Practice Location Address:
BLDG 3089, D STREET
Provider Second Line Business Practice Location Address:
21ST DENTAL COMPANY, MARINE CORPS BASE HAWAII
Provider Business Practice Location Address City Name:
KANEOHE BAY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96863-3037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-257-3100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2010