Provider First Line Business Practice Location Address:
9480 HUEBNER RD
Provider Second Line Business Practice Location Address:
BLDG. 3, STE 320
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78240-1655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-616-0606
Provider Business Practice Location Address Fax Number:
210-692-9573
Provider Enumeration Date:
11/18/2005