Provider First Line Business Practice Location Address:
219 E NAKOMA ST
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:
78216-2704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-736-7102
Provider Business Practice Location Address Fax Number:
210-736-7126
Provider Enumeration Date:
04/26/2006