Provider First Line Business Practice Location Address:
201 WALNUT AVE
Provider Second Line Business Practice Location Address:
VA MARE ISLAND DENTAL SERVICE
Provider Business Practice Location Address City Name:
VALLEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94592-1107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-562-8225
Provider Business Practice Location Address Fax Number:
707-562-8247
Provider Enumeration Date:
01/26/2006