Provider First Line Business Practice Location Address:
15102 HUEBNER 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:
78231-1739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-493-3993
Provider Business Practice Location Address Fax Number:
210-493-1521
Provider Enumeration Date:
07/10/2006