Provider First Line Business Practice Location Address:
2140 BABCOCK 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:
78229-4424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-692-0674
Provider Business Practice Location Address Fax Number:
210-949-1878
Provider Enumeration Date:
05/24/2005