Provider First Line Business Practice Location Address:
2490 7TH ST
Provider Second Line Business Practice Location Address:
AAFES BLDG. 372, SUITE 42
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:
78234-7662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-226-1362
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2006