Provider First Line Business Practice Location Address:
5282 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE 205A
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-4849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-949-0070
Provider Business Practice Location Address Fax Number:
210-949-0277
Provider Enumeration Date:
08/21/2008