Provider First Line Business Practice Location Address:
DEPARTMENT OF PEDIATRICS WILFORD HALL MEDICAL CENTER
Provider Second Line Business Practice Location Address:
2200 BERGQUIST DRIVE,SUITE 1
Provider Business Practice Location Address City Name:
LACKLAND AFB
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78236-5300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-292-5097
Provider Business Practice Location Address Fax Number:
210-292-4777
Provider Enumeration Date:
04/17/2007