Provider First Line Business Practice Location Address:
4018 S PRESA ST
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:
78223-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-533-3655
Provider Business Practice Location Address Fax Number:
210-533-5077
Provider Enumeration Date:
03/19/2007