Provider First Line Business Practice Location Address:
7101 HOFF STREET
Provider Second Line Business Practice Location Address:
HQS, USA DENTAC, ATTN: CREDENTIALS OFFICE
Provider Business Practice Location Address City Name:
FORT BENNING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-544-4530
Provider Business Practice Location Address Fax Number:
706-554-1933
Provider Enumeration Date:
04/04/2006