Provider First Line Business Practice Location Address: 
UNIVERSITY OF TEXAS HSC DENTAL SCHOOL
    Provider Second Line Business Practice Location Address: 
7703 FLOYD CURL DR.
    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: 
210-567-3333
    Provider Business Practice Location Address Fax Number: 
210-567-3334
    Provider Enumeration Date: 
10/27/2006