Provider First Line Business Practice Location Address:
5107 MEDICAL DRIVE
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:
78229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-8612
Provider Business Practice Location Address Fax Number:
210-615-5596
Provider Enumeration Date:
08/29/2006