Provider First Line Business Practice Location Address:
ASD, 187TH MEDICAL BN, 32ND BDE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOINT BASE SAN ANTONIO-FORT SAM HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-221-5731
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2021