Provider First Line Business Practice Location Address:
2122 BABCOCK RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-4411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-865-9200
Provider Business Practice Location Address Fax Number:
210-641-2805
Provider Enumeration Date:
12/27/2007