Provider First Line Business Practice Location Address:
3851 ROGER BROOKE DR
Provider Second Line Business Practice Location Address:
BROOKE ARMY MEDICAL CENTER, DEPT O
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:
78234-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-916-4017
Provider Business Practice Location Address Fax Number:
210-916-1740
Provider Enumeration Date:
11/18/2005