Provider First Line Business Practice Location Address:
4400 S PIEDRAS DR
Provider Second Line Business Practice Location Address:
STE 140 HARRY L SMITH
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78228-1221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-735-7889
Provider Business Practice Location Address Fax Number:
210-735-3060
Provider Enumeration Date:
09/05/2006