Provider First Line Business Practice Location Address:
1060 GAFFNEY RD #7500 USA DENTAC ALASKA
Provider Second Line Business Practice Location Address:
FT. WAINWRIGHT ATTN: CREDENTIALS COORDINATOR
Provider Business Practice Location Address City Name:
FORT WAINWRIGHT
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99703-7500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-361-5530
Provider Business Practice Location Address Fax Number:
907-361-4859
Provider Enumeration Date:
12/03/2008