Provider First Line Business Practice Location Address:
343 W HOUSTON
Provider Second Line Business Practice Location Address:
SUITE C-3
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-6000
Provider Business Practice Location Address Fax Number:
210-614-7728
Provider Enumeration Date:
09/27/2006