Provider First Line Business Practice Location Address:
BLDG 38801 ACADEMIC DR SUITE B & C
Provider Second Line Business Practice Location Address:
USA DENTAC
Provider Business Practice Location Address City Name:
FT GORDON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30905-5660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-787-6927
Provider Business Practice Location Address Fax Number:
706-787-2082
Provider Enumeration Date:
10/03/2016