Provider First Line Business Practice Location Address:
382 TRS (METC)
Provider Second Line Business Practice Location Address:
MIF 2
Provider Business Practice Location Address City Name:
FT SAM HOUSTON
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:
210-808-2201
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2006