Provider First Line Business Practice Location Address:
125 SW MILITARY DR
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:
78221-1650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-922-3483
Provider Business Practice Location Address Fax Number:
210-922-8902
Provider Enumeration Date:
08/05/2006