Provider First Line Business Practice Location Address:
711 E JOSEPHINE ST
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:
78208-1027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-299-8139
Provider Business Practice Location Address Fax Number:
210-212-8128
Provider Enumeration Date:
02/26/2007