Provider First Line Business Practice Location Address: 
11130 CHRISTUS HILLS
    Provider Second Line Business Practice Location Address: 
MEDICAL PLAZA 3, STE 311
    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: 
210-703-9025
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/13/2022