Provider First Line Business Practice Location Address:
124 DALLAS 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:
78205-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-224-1771
Provider Business Practice Location Address Fax Number:
210-229-9138
Provider Enumeration Date:
10/28/2009