Provider First Line Business Practice Location Address:
11103 WEST AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78213-1370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-342-1100
Provider Business Practice Location Address Fax Number:
210-342-1253
Provider Enumeration Date:
09/26/2006