Provider First Line Business Practice Location Address:
3551 ROGER BROOKE DR
Provider Second Line Business Practice Location Address:
BROOKE ARMY MEDICAL CENTER
Provider Business Practice Location Address City Name:
JBSA FT SAM HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78234-4504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-916-0901
Provider Business Practice Location Address Fax Number:
210-916-2100
Provider Enumeration Date:
09/29/2006