Provider First Line Business Practice Location Address:
618TH DENTAL COMPANY(AS)
Provider Second Line Business Practice Location Address:
USA DENTAC-KOREA, 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:
US
Provider Business Practice Location Address Telephone Number:
01182279179061
Provider Business Practice Location Address Fax Number:
01182279167703
Provider Enumeration Date:
10/10/2006