Provider First Line Business Practice Location Address:
3551 ROGER BROOKE DR BLDG 3528R
Provider Second Line Business Practice Location Address:
BAMC DEPT OF BEH MED, ATTN: MCHE-ZDB
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:
78234-4504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-539-9567
Provider Business Practice Location Address Fax Number:
210-539-5467
Provider Enumeration Date:
02/15/2006