Provider First Line Business Practice Location Address:
1633 W KINGS HWY
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:
78201-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-521-0575
Provider Business Practice Location Address Fax Number:
210-521-0574
Provider Enumeration Date:
10/16/2006