Provider First Line Business Practice Location Address:
BLDG 171, 4TH & INNERLOOP
Provider Second Line Business Practice Location Address:
USA DENTAC
Provider Business Practice Location Address City Name:
FORT IRWIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92310-5076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-526-5537
Provider Business Practice Location Address Fax Number:
719-524-2843
Provider Enumeration Date:
01/27/2009