Provider First Line Business Practice Location Address:
1116 E HOUSTON 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:
78205-2031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-226-1482
Provider Business Practice Location Address Fax Number:
210-299-1670
Provider Enumeration Date:
02/10/2012