Provider First Line Business Practice Location Address:
5500 WALZEM
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:
78218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-657-4641
Provider Business Practice Location Address Fax Number:
210-655-4012
Provider Enumeration Date:
09/13/2006