Provider First Line Business Practice Location Address: 
BLDG 301 ANDREWS AVE
    Provider Second Line Business Practice Location Address: 
LYSTER ARMY HEALTH CLINIC
    Provider Business Practice Location Address City Name: 
FORT RUCKER
    Provider Business Practice Location Address State Name: 
AL
    Provider Business Practice Location Address Postal Code: 
36362-5333
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
334-255-7356
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/24/2014