Provider First Line Business Practice Location Address:
5101 MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-4801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-592-5332
Provider Business Practice Location Address Fax Number:
210-614-0649
Provider Enumeration Date:
02/21/2008