Provider First Line Business Practice Location Address:
BLDG. 171, 4TH & INNER LOOP ROAD
Provider Second Line Business Practice Location Address:
U.S. ARMY DENTAL ACTIVITY
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:
760-380-5733
Provider Business Practice Location Address Fax Number:
760-380-4996
Provider Enumeration Date:
05/08/2006