Provider First Line Business Practice Location Address:
333 N SANTA ROSA ST
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL OF SAN ANTONIO
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78207-3108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-704-2686
Provider Business Practice Location Address Fax Number:
210-704-2496
Provider Enumeration Date:
10/25/2005