Provider First Line Business Practice Location Address:
12011 HUEBNER RD
Provider Second Line Business Practice Location Address:
SUITE #111
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78230-1234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-696-4200
Provider Business Practice Location Address Fax Number:
210-579-2215
Provider Enumeration Date:
06/19/2008