Provider First Line Business Practice Location Address:
3851 ROGER BROOKE DR., DPALS
Provider Second Line Business Practice Location Address:
SAN ANTONIO MILITARY MEDICAL CENTER
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-916-8320
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2008