Provider First Line Business Practice Location Address:
5282 MEDICAL DR
Provider Second Line Business Practice Location Address:
STE 520
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-6046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-5481
Provider Business Practice Location Address Fax Number:
210-614-3184
Provider Enumeration Date:
06/01/2005