Provider First Line Business Practice Location Address:
12315 JUDSON RD., SUITE 218
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:
78233-3264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-656-3531
Provider Business Practice Location Address Fax Number:
210-656-3532
Provider Enumeration Date:
06/01/2005