Provider First Line Business Practice Location Address:
59TH DENTAL SQUADRON
Provider Second Line Business Practice Location Address:
204 PAUL WAGNER DR, BUILDING 1739
Provider Business Practice Location Address City Name:
KELLY USA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-292-6647
Provider Business Practice Location Address Fax Number:
210-925-1126
Provider Enumeration Date:
02/07/2006