Provider First Line Business Practice Location Address:
618 DENTAL COMPANY (AS)
Provider Second Line Business Practice Location Address:
UNIT #15662 BLDG. S137 TEXAS AVENUE
Provider Business Practice Location Address City Name:
CAMP CARROLL
Provider Business Practice Location Address State Name:
APO AP
Provider Business Practice Location Address Postal Code:
96260-5662
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
352-765-7185
Provider Business Practice Location Address Fax Number:
352-765-7188
Provider Enumeration Date:
02/08/2006