Provider First Line Business Practice Location Address:
18TH DENTAL SQUADRON
Provider Second Line Business Practice Location Address:
UNIT 5270
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96368-5270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-630-4902
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2005