Provider First Line Business Practice Location Address:
3330 CLARK AVE STE 1
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:
78223-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-532-4858
Provider Business Practice Location Address Fax Number:
210-532-4858
Provider Enumeration Date:
09/16/2006