Provider First Line Business Practice Location Address:
3880 ROGER BROOKE DR.
Provider Second Line Business Practice Location Address:
C/O GENERAL SURGERY DEPT/SAMMC
Provider Business Practice Location Address City Name:
FORT SAM HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78234-8548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-590-8908
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2006