Provider First Line Business Practice Location Address:
4410 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-6306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-2100
Provider Business Practice Location Address Fax Number:
210-692-1999
Provider Enumeration Date:
07/05/2005