Provider First Line Business Practice Location Address:
82 DENTAL SQUADRON SGD
Provider Second Line Business Practice Location Address:
149 HART STREET STE 4
Provider Business Practice Location Address City Name:
SHEPPARD AFB
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-676-4474
Provider Business Practice Location Address Fax Number:
940-676-5903
Provider Enumeration Date:
12/14/2005