Provider First Line Business Practice Location Address:
21ST DENTAL COMPANY
Provider Second Line Business Practice Location Address:
BOX 63037
Provider Business Practice Location Address City Name:
MCBH KANEOHE BAY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-257-3100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2005