Provider First Line Business Practice Location Address:
3939 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE 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:
78229-2291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-450-6120
Provider Business Practice Location Address Fax Number:
210-450-6161
Provider Enumeration Date:
08/03/2005