Provider First Line Business Practice Location Address:
10000 ROGERS RUN ROAD
Provider Second Line Business Practice Location Address:
KOHL'S WELLNESS CENTER
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-680-0460
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2005