Provider First Line Business Practice Location Address:
1322 E HOUSTON ST STE B
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:
78205-2035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-223-8130
Provider Business Practice Location Address Fax Number:
210-223-9878
Provider Enumeration Date:
07/08/2008