Provider First Line Business Practice Location Address:
9502 HUEBNER RD STE 101
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:
78240-1683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-767-2258
Provider Business Practice Location Address Fax Number:
210-767-2259
Provider Enumeration Date:
11/10/2005