Provider First Line Business Practice Location Address:
BLDG 171, 4TH AND INNER LOOP RD
Provider Second Line Business Practice Location Address:
FORT IRWIN DENTAL CLINIC COMMAND
Provider Business Practice Location Address City Name:
FORT IRWIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92310-5076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-380-4990
Provider Business Practice Location Address Fax Number:
760-380-4996
Provider Enumeration Date:
11/16/2012