Provider First Line Business Practice Location Address:
76 NEALY AVE
Provider Second Line Business Practice Location Address:
1ST DENTAL SQUADRON/SGD
Provider Business Practice Location Address City Name:
LANGLEY AIR FORCE BASE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-764-9643
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2008