Provider First Line Business Practice Location Address:
4270 GORGAS CIR BLDG 1070
Provider Second Line Business Practice Location Address:
US ARMY DENTAL COMMAND
Provider Business Practice Location Address City Name:
FORT SAM HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78234-2639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-221-8441
Provider Business Practice Location Address Fax Number:
210-221-8810
Provider Enumeration Date:
01/20/2010