Provider First Line Business Practice Location Address:
7400 MERTON MINTER ST
Provider Second Line Business Practice Location Address:
CLINIC 1G
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-4404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-949-3045
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2011