Provider First Line Business Practice Location Address: 
2050 WORTH ROAD
    Provider Second Line Business Practice Location Address: 
SUITE 10 HQ MEDCOM ATTN DR ORMAN
    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: 
78234-6010
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
210-221-6792
    Provider Business Practice Location Address Fax Number: 
210-221-6894
    Provider Enumeration Date: 
07/07/2005