Provider First Line Business Practice Location Address:
12333 WETMORE RD
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:
78247-3638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-495-6477
Provider Business Practice Location Address Fax Number:
210-495-6484
Provider Enumeration Date:
08/09/2005