Provider First Line Business Practice Location Address:
5282 MEDICAL DR.
Provider Second Line Business Practice Location Address:
#316
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-6044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-696-7500
Provider Business Practice Location Address Fax Number:
210-692-0248
Provider Enumeration Date:
03/06/2007