Provider First Line Business Practice Location Address:
BAMC
Provider Second Line Business Practice Location Address:
3851 ROGER BROOKE DRIVE MCHE-QD (CREDS)
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:
361-961-3151
Provider Business Practice Location Address Fax Number:
361-961-4823
Provider Enumeration Date:
05/18/2006