Provider First Line Business Practice Location Address:
5202 CANARY HOLW
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:
78222-4902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-333-9143
Provider Business Practice Location Address Fax Number:
210-333-6664
Provider Enumeration Date:
05/15/2006