Provider First Line Business Practice Location Address:
WILFORD HALL MEDICAL CENTER /759TH MDSS/MSBU
Provider Second Line Business Practice Location Address:
2200 BERGQUIST DRIVE, SUITE 1
Provider Business Practice Location Address City Name:
LACKLAND AIR FORCE BASE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-292-7504
Provider Business Practice Location Address Fax Number:
210-292-4855
Provider Enumeration Date:
01/19/2006