Provider First Line Business Practice Location Address:
351 W 6TH ST
Provider Second Line Business Practice Location Address:
SUITE 19 BLDG 440 US ARMY DENTAL ACTIVITY
Provider Business Practice Location Address City Name:
FT STEWART
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31314-4707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-767-6735
Provider Business Practice Location Address Fax Number:
912-767-5425
Provider Enumeration Date:
11/13/2007