Provider First Line Business Practice Location Address:
5282 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-4849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-692-6736
Provider Business Practice Location Address Fax Number:
210-692-0821
Provider Enumeration Date:
06/27/2006