Provider First Line Business Practice Location Address:
2397 C NW MILITARY HWY
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:
78231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-341-3222
Provider Business Practice Location Address Fax Number:
210-349-4891
Provider Enumeration Date:
11/09/2006