Provider First Line Business Practice Location Address:
4242 MEDICAL DR
Provider Second Line Business Practice Location Address:
BLDG 100, SUITE 1100
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-736-1812
Provider Business Practice Location Address Fax Number:
210-737-0843
Provider Enumeration Date:
01/17/2008