Provider First Line Business Practice Location Address:
1802 SW MILITARY DR
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:
78221-1431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-924-2337
Provider Business Practice Location Address Fax Number:
210-923-2208
Provider Enumeration Date:
10/17/2005