Provider First Line Business Practice Location Address:
BAMC
Provider Second Line Business Practice Location Address:
3851 ROGER BROOKE DRIVE
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:
78234-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-916-5586
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2005