Provider First Line Business Practice Location Address:
2926 PAT BOOKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIVERSAL CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78148-2732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-659-2955
Provider Business Practice Location Address Fax Number:
210-659-7398
Provider Enumeration Date:
09/04/2009