Provider First Line Business Practice Location Address:
2202 UNIVERSAL CITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIVERSAL CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-658-4941
Provider Business Practice Location Address Fax Number:
210-945-4558
Provider Enumeration Date:
11/22/2006