Provider First Line Business Practice Location Address:
9819 HUEBNER RD BLDG 2
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:
78240-3253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-704-4966
Provider Business Practice Location Address Fax Number:
210-704-4718
Provider Enumeration Date:
09/07/2005