Provider First Line Business Practice Location Address:
7410 JOHN SMITH
Provider Second Line Business Practice Location Address:
STE 214
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-6000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-849-1244
Provider Business Practice Location Address Fax Number:
210-691-0111
Provider Enumeration Date:
06/22/2005