Provider First Line Business Practice Location Address:
1015 SHOOK AVE
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:
78212-2508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-826-2373
Provider Business Practice Location Address Fax Number:
210-826-2374
Provider Enumeration Date:
09/27/2005