Provider First Line Business Practice Location Address:
US ARMY DENTAL ACTIVITY ATTN CREDENTIALS COORDINATOR
Provider Second Line Business Practice Location Address:
10205 N RIVA RIDGE LOOP
Provider Business Practice Location Address City Name:
FORT DRUM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13602-5005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-772-6234
Provider Business Practice Location Address Fax Number:
315-774-3558
Provider Enumeration Date:
11/21/2005