Provider First Line Business Practice Location Address:
618TH DENTAL COMPANY (AS)
Provider Second Line Business Practice Location Address:
UNIT #15652
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96205-5652
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
315-736-7715
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2005