Provider First Line Business Practice Location Address:
J STREET BLDG 3000
Provider Second Line Business Practice Location Address:
FEDERAL MEDICAL CENTER CARSWELL
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76127-0066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-782-4606
Provider Business Practice Location Address Fax Number:
817-782-4627
Provider Enumeration Date:
02/22/2011