Provider First Line Business Practice Location Address:
BAMC-3551 ROGER BROOKE DRIVE
Provider Second Line Business Practice Location Address:
MCHE-QD (CREDS), FORT SAM HOUSTON
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78234-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-808-2237
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2012