Provider First Line Business Practice Location Address:
1055 ADA ST
Provider Second Line Business Practice Location Address:
SOUTHEAST CLINIC
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78223-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-567-5051
Provider Business Practice Location Address Fax Number:
210-567-4963
Provider Enumeration Date:
08/24/2006