Provider First Line Business Practice Location Address:
7142 SAN PEDRO AVE
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78216-6256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-661-5622
Provider Business Practice Location Address Fax Number:
210-798-6811
Provider Enumeration Date:
12/06/2005