Provider First Line Business Practice Location Address:
2018 ARMY BLVD, APT A
Provider Second Line Business Practice Location Address:
USA DENTAC
Provider Business Practice Location Address City Name:
FT SAM HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-221-0826
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2006