Provider First Line Business Mailing Address:
7223 MISSISSIPPI AVE, BLDG 1561
Provider Second Line Business Mailing Address:
US ARMY DENTAL ACTIVITY, ATTN: CREDENTIALS
Provider Business Mailing Address City Name:
FORT POLK
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-259-2288
Provider Business Mailing Address Fax Number: