Provider First Line Business Practice Location Address:
4242 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE 6250
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:
210-479-3297
Provider Business Practice Location Address Fax Number:
210-479-3295
Provider Enumeration Date:
06/09/2006