Provider First Line Business Practice Location Address:
BLDG 128 CHAFFEE ROAD
Provider Second Line Business Practice Location Address:
ATTN: DENTAC HEADQUARTERS US ARMY DENTAL ACTIVITY,
Provider Business Practice Location Address City Name:
FT BLISS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-742-6001
Provider Business Practice Location Address Fax Number:
915-742-7462
Provider Enumeration Date:
06/14/2016