Provider First Line Business Practice Location Address:
UNIT 26610
Provider Second Line Business Practice Location Address:
WUEZBURG DENTAL ACTIVITY CREDENTIALS OFFICE
Provider Business Practice Location Address City Name:
APO AE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
09244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-804-3933
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2006