Provider First Line Business Practice Location Address:
THEATER DENTAL COMMAND 618TH
Provider Second Line Business Practice Location Address:
UNIT #15660
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96271-5660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-753-6559
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2009