Provider First Line Business Practice Location Address:
4941 WALZEM 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:
78218-2176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-656-6303
Provider Business Practice Location Address Fax Number:
210-590-1064
Provider Enumeration Date:
12/21/2006