Provider First Line Business Practice Location Address: 
36000 DARNALL LOOP
    Provider Second Line Business Practice Location Address: 
DEPT OF ORTHOPEDICS CARL R DARNALL ARMY MEDICAL CENTER
    Provider Business Practice Location Address City Name: 
FORT HOOD
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
76544
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
254-288-8190
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/20/2006