Provider First Line Business Practice Location Address:
4242 MEDICAL DR
Provider Second Line Business Practice Location Address:
#6100
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-5640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-692-1245
Provider Business Practice Location Address Fax Number:
940-692-1244
Provider Enumeration Date:
06/05/2007