Provider First Line Business Practice Location Address:
11212 STATE HIGHWAY 151 STE 110
Provider Second Line Business Practice Location Address:
PLAZA-2
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78251-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-543-1579
Provider Business Practice Location Address Fax Number:
210-543-1581
Provider Enumeration Date:
10/12/2011