Provider First Line Business Practice Location Address:
38717 38TH STREET
Provider Second Line Business Practice Location Address:
DENTAC CREDENTIALS OFFICE
Provider Business Practice Location Address City Name:
FORT GORDON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30905-5660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-787-6927
Provider Business Practice Location Address Fax Number:
706-787-2082
Provider Enumeration Date:
08/08/2012