Provider First Line Business Practice Location Address:
59 DG-AF POSTGRADUATE DENTAL SCHOOL
Provider Second Line Business Practice Location Address:
2133 PEPPERRELL ST. BLDG #3352
Provider Business Practice Location Address City Name:
JBSA-LACKLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-292-6258
Provider Business Practice Location Address Fax Number:
210-292-2618
Provider Enumeration Date:
08/01/2013