Provider First Line Business Practice Location Address:
1406 FITCH 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:
78211-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-922-6922
Provider Business Practice Location Address Fax Number:
210-921-1313
Provider Enumeration Date:
06/19/2006