Provider First Line Business Practice Location Address:
3118 CLARK AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78210-5776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-533-7000
Provider Business Practice Location Address Fax Number:
210-533-3770
Provider Enumeration Date:
06/20/2006