Provider First Line Business Practice Location Address: 
9901 IH 10 W
    Provider Second Line Business Practice Location Address: 
SUITE 800
    Provider Business Practice Location Address City Name: 
SAN ANTONIO
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
78230-2246
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
210-302-8226
    Provider Business Practice Location Address Fax Number: 
210-641-0545
    Provider Enumeration Date: 
10/15/2009