Provider First Line Business Practice Location Address:
2050 WORTH 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:
78234-7533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-221-6017
Provider Business Practice Location Address Fax Number:
210-221-7850
Provider Enumeration Date:
05/22/2007