Provider First Line Business Practice Location Address:
398 192ND ARMOR TANK BATTALION RD
Provider Second Line Business Practice Location Address:
US ARMY DENTAL ACTIVITY BLDG 1022 RM 231
Provider Business Practice Location Address City Name:
FORT KNOX
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40121-5116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-624-6158
Provider Business Practice Location Address Fax Number:
502-624-2966
Provider Enumeration Date:
07/28/2014