Provider First Line Business Practice Location Address:
8666 HUEBNER RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78240-1844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-696-1084
Provider Business Practice Location Address Fax Number:
210-696-1085
Provider Enumeration Date:
10/13/2005