Provider First Line Business Practice Location Address:
2724 BRAVE RIFLES REGIMENT RD
Provider Second Line Business Practice Location Address:
HQS US ARMY DENTAL ACTIVITY
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-624-6158
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2006