Provider First Line Business Practice Location Address:
448 CASTROVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78207-5147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-434-1400
Provider Business Practice Location Address Fax Number:
210-431-7472
Provider Enumeration Date:
07/20/2005