Provider First Line Business Practice Location Address: 
8300 FLOYD CURL DR FL 3
    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: 
78229-3931
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
210-450-4888
    Provider Business Practice Location Address Fax Number: 
210-450-6018
    Provider Enumeration Date: 
08/24/2006