Provider First Line Business Practice Location Address:
BOX 81 618TH DENTAL CO. (AS)
Provider Second Line Business Practice Location Address:
UNIT 15652
Provider Business Practice Location Address City Name:
APO AP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96205-5652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
10-394-1653
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2016