Provider First Line Business Practice Location Address:
3030 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:
78214-2337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-924-8151
Provider Business Practice Location Address Fax Number:
210-924-2208
Provider Enumeration Date:
07/13/2005