Provider First Line Business Practice Location Address:
2128 NW MILITARY
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:
78213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-349-3750
Provider Business Practice Location Address Fax Number:
210-349-4142
Provider Enumeration Date:
10/23/2006