Provider First Line Business Practice Location Address:
659 STEVES AVE
Provider Second Line Business Practice Location Address:
CONCENTRA AT L&H PACKING
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-532-3241
Provider Business Practice Location Address Fax Number:
210-531-1296
Provider Enumeration Date:
10/12/2005