Provider First Line Business Practice Location Address:
301 ANDREWS AVE
Provider Second Line Business Practice Location Address:
LYSTER ARMY HEALTH CLINIC BLDG
Provider Business Practice Location Address City Name:
FORT RUCKER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-255-7755
Provider Business Practice Location Address Fax Number:
334-255-7060
Provider Enumeration Date:
04/02/2008