Provider First Line Business Practice Location Address:
7608 W MILITARY DR
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:
78227-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-645-0000
Provider Business Practice Location Address Fax Number:
210-673-3616
Provider Enumeration Date:
11/29/2006