Provider First Line Business Practice Location Address:
2522 W COMMERCE 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:
78207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-225-4867
Provider Business Practice Location Address Fax Number:
210-225-5643
Provider Enumeration Date:
11/27/2006