Provider First Line Business Practice Location Address:
19500 IH 10 W BLDG 1
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:
78257-9509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
726-567-6300
Provider Business Practice Location Address Fax Number:
145-935-1000
Provider Enumeration Date:
11/13/2006