Provider First Line Business Practice Location Address:
DENTAL CLINIC, 1067 TWINING DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARKSDALE AIR FORCE BASE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71111-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-456-6791
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2018