Provider First Line Business Practice Location Address:
4499 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE 235
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-692-1613
Provider Business Practice Location Address Fax Number:
210-616-0290
Provider Enumeration Date:
02/17/2006