Provider First Line Business Practice Location Address:
3145 GARDEN AVENUE
Provider Second Line Business Practice Location Address:
FORT SAM HOUSTON BUDGE DENTAL CLINIC
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-808-3672
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2006