Provider First Line Business Practice Location Address:
3851 ROGER BROOKE DR
Provider Second Line Business Practice Location Address:
SAN ANTONIO MILITARY MEDICAL CENTER
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:
78234-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-775-4105
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2007