Provider First Line Business Practice Location Address:
2458 HARRY WURZBACH RD
Provider Second Line Business Practice Location Address:
1B
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78209-5002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-822-3055
Provider Business Practice Location Address Fax Number:
210-822-3044
Provider Enumeration Date:
08/31/2006