Provider First Line Business Practice Location Address:
3100 SCOFIELD ROAD #1179
Provider Second Line Business Practice Location Address:
FORT SAM HOUSTON PRIMARY CARE CLINIC
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-808-2470
Provider Business Practice Location Address Fax Number:
210-808-3515
Provider Enumeration Date:
11/09/2005