Provider First Line Business Practice Location Address:
727 S ALAMO 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:
78205-3463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-225-0101
Provider Business Practice Location Address Fax Number:
210-225-5969
Provider Enumeration Date:
09/15/2006