Provider First Line Business Practice Location Address:
2133 PEPPERRELL ST BLDG 3352
Provider Second Line Business Practice Location Address:
AF POSTGRADUATE DENTAL SCHOOL
Provider Business Practice Location Address City Name:
LACKLAND A F B
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78236-5313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-292-7115
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2011