Provider First Line Business Practice Location Address:
3851 ROGER BROOKE DR
Provider Second Line Business Practice Location Address:
PHYSICAL MEDICINE SERVICE, BAMC
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78234-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-916-0306
Provider Business Practice Location Address Fax Number:
210-916-0598
Provider Enumeration Date:
10/24/2005