Provider First Line Business Practice Location Address:
8299 FREDERICKSBURG RD
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:
78229-3359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-753-2663
Provider Business Practice Location Address Fax Number:
210-617-7542
Provider Enumeration Date:
06/12/2006