Provider First Line Business Practice Location Address: 
3066 E COMMERCE ST
    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: 
78220-1013
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
210-233-7000
    Provider Business Practice Location Address Fax Number: 
210-233-7199
    Provider Enumeration Date: 
09/30/2024