Provider First Line Business Practice Location Address:
12626 LA ENTRADA ST
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:
78233-6328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-264-2246
Provider Business Practice Location Address Fax Number:
210-637-7015
Provider Enumeration Date:
01/13/2007