Provider First Line Business Practice Location Address:
7010 MORRISON AVE BLDG 128
Provider Second Line Business Practice Location Address:
DENTAL ACTIVITY
Provider Business Practice Location Address City Name:
FORT BENNING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31905-0102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-544-4530
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2007