Provider First Line Business Practice Location Address:
12315 JUDSON RD STE 118
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:
78233-3263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-655-7271
Provider Business Practice Location Address Fax Number:
210-655-7539
Provider Enumeration Date:
12/29/2010