Provider First Line Business Practice Location Address:
BROOKE ARMY MEDICAL CENTER MCHE-QD/CREDENTIALS
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:
78234-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-916-7808
Provider Business Practice Location Address Fax Number:
210-916-4074
Provider Enumeration Date:
11/01/2005