Provider First Line Business Practice Location Address:
999 E BASSE RD STE 155
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:
78209-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-822-1110
Provider Business Practice Location Address Fax Number:
210-822-1379
Provider Enumeration Date:
02/20/2007