Provider First Line Business Practice Location Address:
4410 MEDICAL DR
Provider Second Line Business Practice Location Address:
STE#100
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-6306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-4000
Provider Business Practice Location Address Fax Number:
210-614-9114
Provider Enumeration Date:
08/09/2005