Provider First Line Business Practice Location Address:
271 FORT RICHARDSON AVE
Provider Second Line Business Practice Location Address:
GOODFELLOW AFB CLINIC
Provider Business Practice Location Address City Name:
GOODFELLOW AIR FORCE BASE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-654-3238
Provider Business Practice Location Address Fax Number:
325-654-3083
Provider Enumeration Date:
10/12/2006