Provider First Line Business Practice Location Address:
VA NCHCS- DENTAL SERVICE
Provider Second Line Business Practice Location Address:
BLDG 201 WALNUT AVE
Provider Business Practice Location Address City Name:
MARE ISLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-562-8236
Provider Business Practice Location Address Fax Number:
707-562-8247
Provider Enumeration Date:
12/14/2005