Provider First Line Business Practice Location Address:
8219 FREDERICKSBURG 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:
78229-3355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-3332
Provider Business Practice Location Address Fax Number:
210-614-3331
Provider Enumeration Date:
12/18/2006