Provider First Line Business Practice Location Address:
219 E CRAIG PL
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:
78212-3547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-227-3612
Provider Business Practice Location Address Fax Number:
210-227-3621
Provider Enumeration Date:
03/30/2009