Provider First Line Business Practice Location Address:
3454 ROOSEVELT AVE.
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:
78214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-546-1337
Provider Business Practice Location Address Fax Number:
210-546-1348
Provider Enumeration Date:
06/02/2011