Provider First Line Business Practice Location Address:
3519 PAESANOS PKWY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78231-1264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-444-9312
Provider Business Practice Location Address Fax Number:
210-444-9315
Provider Enumeration Date:
11/30/2005