Provider First Line Business Practice Location Address:
1200 BROOKLYN AVE
Provider Second Line Business Practice Location Address:
320
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78212-4803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-396-5327
Provider Business Practice Location Address Fax Number:
210-396-5353
Provider Enumeration Date:
06/01/2006