Provider First Line Business Practice Location Address:
8211 FREDERICKSBURG RD
Provider Second Line Business Practice Location Address:
SEVILLE PARK ENDODONTICS PLLC
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:
210-617-5536
Provider Business Practice Location Address Fax Number:
210-614-4266
Provider Enumeration Date:
09/11/2006