Provider First Line Business Practice Location Address:
DENTAC
Provider Second Line Business Practice Location Address:
618 MD CO DENTAL
Provider Business Practice Location Address City Name:
YONGHSAN
Provider Business Practice Location Address State Name:
REPUBLIC OF KOREA
Provider Business Practice Location Address Postal Code:
APO AP 96205
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
82279168803
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/30/2005