Registry details
Type
Individual
Primary specialty
Dentist
Enumerated
Jul 12, 2011
License(s)
1111111111 (TN), DN27904 (FL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | WILFORD HALL AMB SURG CENTER JBSA LACKLAND, AB, TX | Jbsa Lackland, TX 78259 | |
| LOCATION | 1615 TRUEMPER ST | Jbsa Lackland, TX 78236-5511 | 210-292-8980 |
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