Provider First Line Business Practice Location Address:
618TH DENTAL COMPANY (AS), USA DENTAC - K
Provider Second Line Business Practice Location Address:
UNIT #15652
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96205-5652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
11-822-7917
Provider Business Practice Location Address Fax Number:
11-822-7703
Provider Enumeration Date:
08/12/2014