Provider First Line Business Practice Location Address:
201 PAT BOOKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIVERSAL CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78148-4427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-658-1513
Provider Business Practice Location Address Fax Number:
210-658-4841
Provider Enumeration Date:
08/27/2005