Provider First Line Business Practice Location Address:
1518 AUSTIN HWY STE 13
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:
78218-6047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-824-9595
Provider Business Practice Location Address Fax Number:
210-826-8588
Provider Enumeration Date:
08/21/2006