Provider First Line Business Practice Location Address:
618TH DENTAL CO, CARIUS DENTAL CLINIC BLDG# P3020 ATTN:
Provider Second Line Business Practice Location Address:
CREDENTIAL OFFICE
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96271-5245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-737-9186
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2015