Provider First Line Business Practice Location Address:
5005 N. PIEDRAS STREET USA DENTAC - FT BLISS
Provider Second Line Business Practice Location Address:
BLDG. 128, USA DENTAC - FT BLISS ATTN: PAMELA LOPEZ
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79920-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-568-5935
Provider Business Practice Location Address Fax Number:
915-568-5174
Provider Enumeration Date:
09/22/2008