Provider First Line Business Practice Location Address:
4330 VANCE JACKSON RD
Provider Second Line Business Practice Location Address:
NIX SPECIALTY HOSPITAL
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78230-5321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-579-3822
Provider Business Practice Location Address Fax Number:
210-443-4449
Provider Enumeration Date:
07/28/2005