Provider First Line Business Practice Location Address:
6711 S NEW BRAUNFELS AVE STE 500
Provider Second Line Business Practice Location Address:
MEDICAL SERVICES DEPARTMENT, BLDG 667E
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78223-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-532-9610
Provider Business Practice Location Address Fax Number:
210-531-3795
Provider Enumeration Date:
11/06/2006