Provider First Line Business Practice Location Address:
5282 MEDICAL DR STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-6072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-862-8470
Provider Business Practice Location Address Fax Number:
210-878-4297
Provider Enumeration Date:
09/24/2010