Provider First Line Business Practice Location Address:
520 CAMDEN 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:
78215-1924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-223-3246
Provider Business Practice Location Address Fax Number:
210-223-1816
Provider Enumeration Date:
07/28/2006