Provider First Line Business Practice Location Address:
1ST DENTAL BN/NDC CAMP PENDLETON
Provider Second Line Business Practice Location Address:
BOX 555221
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AA
Provider Business Practice Location Address Postal Code:
92054-2055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-5419
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2013