Provider First Line Business Practice Location Address:
10419 OLD PRUE RD
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:
78249-4137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-397-6700
Provider Business Practice Location Address Fax Number:
210-257-4340
Provider Enumeration Date:
10/28/2025