Provider First Line Business Practice Location Address:
2724 BRAVE RIFLES REGIMENT ROAD
Provider Second Line Business Practice Location Address:
HQ USA DENTAL ACTIVITY
Provider Business Practice Location Address City Name:
FORT KNOX
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40121-5111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-465-3203
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2006