Provider First Line Business Practice Location Address:
8109 FREDERICKSBURG RD
Provider Second Line Business Practice Location Address:
PHYSICIAN PRACTICE SERVICES
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-575-0254
Provider Business Practice Location Address Fax Number:
210-575-0167
Provider Enumeration Date:
03/13/2012