Provider First Line Business Practice Location Address:
1028 S ALAMO 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:
78210-1170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-281-1878
Provider Business Practice Location Address Fax Number:
210-281-1759
Provider Enumeration Date:
11/05/2008