Provider First Line Business Practice Location Address:
2118 FREDERICKSBURG 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:
78201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-737-2040
Provider Business Practice Location Address Fax Number:
210-737-9131
Provider Enumeration Date:
08/30/2006