Provider First Line Business Practice Location Address:
2950 KOEHLER RD
Provider Second Line Business Practice Location Address:
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:
78234-7535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-822-9445
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2007