Provider First Line Business Practice Location Address:
1811 ARMY BLVD
Provider Second Line Business Practice Location Address:
APT A BLDG 2018
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:
78234-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-221-0835
Provider Business Practice Location Address Fax Number:
210-221-0824
Provider Enumeration Date:
08/01/2006