Provider First Line Business Practice Location Address:
11212 TX-151
Provider Second Line Business Practice Location Address:
MEDICAL PLAZA I, STE 230
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78251-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-703-8556
Provider Business Practice Location Address Fax Number:
210-703-8557
Provider Enumeration Date:
04/04/2012