Provider First Line Business Practice Location Address:
13620 NW MILITARY HWY.
Provider Second Line Business Practice Location Address:
BLDG. 3, SUITE 2
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:
210-978-4341
Provider Business Practice Location Address Fax Number:
210-698-9188
Provider Enumeration Date:
08/12/2006