Provider First Line Business Practice Location Address:
351 WEST 6TH STREET, BLDG 440
Provider Second Line Business Practice Location Address:
USA DENTAC - ATTN: CREDENTIALS
Provider Business Practice Location Address City Name:
FORT STEWART
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31314-4704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-767-6735
Provider Business Practice Location Address Fax Number:
912-870-6735
Provider Enumeration Date:
08/09/2006