Provider First Line Business Practice Location Address:
1006 CENTRAL PKWY S
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:
78232-5021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-490-9169
Provider Business Practice Location Address Fax Number:
210-545-7740
Provider Enumeration Date:
10/31/2006