Provider First Line Business Practice Location Address:
12227 HUEBNER RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78230-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-485-1488
Provider Business Practice Location Address Fax Number:
210-485-1489
Provider Enumeration Date:
11/19/2007