Provider First Line Business Practice Location Address:
1354 BASSE RD
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78212-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-822-6992
Provider Business Practice Location Address Fax Number:
210-822-6997
Provider Enumeration Date:
04/17/2008