Provider First Line Business Practice Location Address:
12930 W INTERSTATE 10
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:
78249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-255-6234
Provider Business Practice Location Address Fax Number:
210-255-6121
Provider Enumeration Date:
10/19/2006