Provider First Line Business Practice Location Address:
3551 ROGERS BROOKE DRIVE
Provider Second Line Business Practice Location Address:
SAN ANTONIO MILITARY MEDICAL CENTER
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:
78234-9416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-916-9844
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2007