Provider First Line Business Practice Location Address:
US ARMY DENTAL ACTIVITY ATTN CREDENTIALS COORDINATOR
Provider Second Line Business Practice Location Address:
10205 NORTH RIVA RIDGE LOOP
Provider Business Practice Location Address City Name:
FORT DRUM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13603-5005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-772-4342
Provider Business Practice Location Address Fax Number:
315-772-9692
Provider Enumeration Date:
01/11/2006