Provider First Line Business Practice Location Address:
4242 MEDICAL DR STE 6100
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:
78229-5643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-896-2900
Provider Business Practice Location Address Fax Number:
830-792-5952
Provider Enumeration Date:
10/19/2006