Provider First Line Business Practice Location Address:
3655 FREDERICKSBURG RD STE 112
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:
78201-3859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-733-9990
Provider Business Practice Location Address Fax Number:
210-733-1878
Provider Enumeration Date:
12/22/2005