Provider First Line Business Practice Location Address:
5005 N PIEADRAS
Provider Second Line Business Practice Location Address:
US ARMY DENTAL ACTIVITY
Provider Business Practice Location Address City Name:
EL PSSO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79920-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-742-2511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2016