Provider First Line Business Practice Location Address:
2004 E HOUSTON 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:
78202-2934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-224-7676
Provider Business Practice Location Address Fax Number:
210-224-6131
Provider Enumeration Date:
11/17/2006