Provider First Line Business Practice Location Address:
59TH DENTAL TRAINING SQUADRON
Provider Second Line Business Practice Location Address:
2133 PEPPERRELL STREET
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-292-6959
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2006