Provider First Line Business Practice Location Address:
3019 INTERSTATE DR.
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:
78219-1708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-227-5262
Provider Business Practice Location Address Fax Number:
210-227-2118
Provider Enumeration Date:
07/08/2006