Provider First Line Business Practice Location Address:
301 ANDREWS AVE
Provider Second Line Business Practice Location Address:
LYSTER ARMY HEALTH CLINIC BUILDING
Provider Business Practice Location Address City Name:
FORT RUCKER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36362-5333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-255-7894
Provider Business Practice Location Address Fax Number:
334-255-7368
Provider Enumeration Date:
03/28/2008