Provider First Line Business Practice Location Address:
1601 SW ARCHER RD
Provider Second Line Business Practice Location Address:
DENTAL SERVICE (160), V.A. MEDICAL CENTER
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32608-1135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-376-1611
Provider Business Practice Location Address Fax Number:
352-379-7450
Provider Enumeration Date:
09/20/2006