Provider First Line Business Practice Location Address: 
4301 MOW-WAY RD
    Provider Second Line Business Practice Location Address: 
REYNOLDS ARMY COMMUNITY HOSPITAL (MS. PRESCOTT)
    Provider Business Practice Location Address City Name: 
FORT SILL
    Provider Business Practice Location Address State Name: 
OK
    Provider Business Practice Location Address Postal Code: 
73503-6300
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
580-458-2134
    Provider Business Practice Location Address Fax Number: 
580-458-2314
    Provider Enumeration Date: 
10/25/2006