Provider First Line Business Practice Location Address:
1445 SOMERSET RD STE 1
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:
78211-3007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-924-6649
Provider Business Practice Location Address Fax Number:
210-924-0198
Provider Enumeration Date:
12/28/2006