Provider First Line Business Practice Location Address:
12000 HUEBNER RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78230-1209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-561-2422
Provider Business Practice Location Address Fax Number:
210-561-2466
Provider Enumeration Date:
12/13/2005