Provider First Line Business Practice Location Address:
1585 THIRD STREET
Provider Second Line Business Practice Location Address:
USA DENTAC
Provider Business Practice Location Address City Name:
FT POLK
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-531-4762
Provider Business Practice Location Address Fax Number:
337-531-6506
Provider Enumeration Date:
08/20/2009