Provider First Line Business Practice Location Address:
398 192ND ARMORED TANK BATTALION RD, BLDG 1022 RM 231
Provider Second Line Business Practice Location Address:
USA DENTAC
Provider Business Practice Location Address City Name:
FORT KNOX
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40121-5116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-624-6158
Provider Business Practice Location Address Fax Number:
502-624-2966
Provider Enumeration Date:
10/22/2007