Provider First Line Business Practice Location Address:
11212 STATE HIGHWAY 151
Provider Second Line Business Practice Location Address:
SUITE 105-MEDICAL PLAZA II
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-309-1405
Provider Business Practice Location Address Fax Number:
210-477-5224
Provider Enumeration Date:
06/20/2017