Provider First Line Business Practice Location Address:
999 EAST BASSE
Provider Second Line Business Practice Location Address:
#105
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-824-7001
Provider Business Practice Location Address Fax Number:
210-824-8840
Provider Enumeration Date:
09/19/2007