Provider First Line Business Practice Location Address:
5282 MEDICAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 440
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:
210-614-3300
Provider Business Practice Location Address Fax Number:
210-614-3636
Provider Enumeration Date:
11/22/2006