Provider First Line Business Practice Location Address:
FORT POLK DENTAC
Provider Second Line Business Practice Location Address:
1585 3RD STREET, STE 6119A
Provider Business Practice Location Address City Name:
FORT POLK
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-531-4400
Provider Business Practice Location Address Fax Number:
337-531-4715
Provider Enumeration Date:
10/06/2006