Provider Information for 1508321274
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AUNDRA LAVON CONYER
Sex: Male
NPI: 1508321274
Last Updated: 2019-02-06
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1508321274 | ||||||||
| Enumeration Date | 2019-02-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3615 CULEBRA RD SAN ANTONIO, TX 78228-5914 United States Phone: 210-314-6473 | Fax: | ||||||||
| Primary Practice Address | 3615 CULEBRA RD SAN ANTONIO, TX 78228-5914 United States Phone: 210-314-6473 | Fax:210-314-8676 | ||||||||
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