Provider First Line Business Practice Location Address:
8310 EWING HALSELL 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:
78229-3715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-616-0885
Provider Business Practice Location Address Fax Number:
210-614-5633
Provider Enumeration Date:
08/07/2009