Provider First Line Business Practice Location Address:
11212 STATE HIGHWAY 151
Provider Second Line Business Practice Location Address:
PLAZA 1, STE 200
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78251-4498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-520-7160
Provider Business Practice Location Address Fax Number:
210-520-7190
Provider Enumeration Date:
06/17/2005