Provider First Line Business Practice Location Address:
1631 WETZEL AVENUE, BLDG 815
Provider Second Line Business Practice Location Address:
US ARMY DENTAL ACTIVITY
Provider Business Practice Location Address City Name:
FORT CARSON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-526-5537
Provider Business Practice Location Address Fax Number:
719-526-5551
Provider Enumeration Date:
08/17/2006