Provider First Line Business Practice Location Address:
1055 ADA ST.
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:
78223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-358-5758
Provider Business Practice Location Address Fax Number:
210-358-5758
Provider Enumeration Date:
07/19/2006