Provider First Line Business Practice Location Address:
DEPT OF THE ARMY, DENTAL ACTIVITY
Provider Second Line Business Practice Location Address:
1724 NEBRASKA AVE, BLDG 1608
Provider Business Practice Location Address City Name:
FT LEONARD WOOD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65473-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-596-0388
Provider Business Practice Location Address Fax Number:
573-596-0410
Provider Enumeration Date:
03/31/2006