Provider First Line Business Practice Location Address:
520 POPE AVENUE
Provider Second Line Business Practice Location Address:
US ARMY DENTAL ACTIVITY
Provider Business Practice Location Address City Name:
FT. LEAVENWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-239-7241
Provider Business Practice Location Address Fax Number:
785-239-7245
Provider Enumeration Date:
01/23/2007