Provider First Line Business Practice Location Address:
1315 TEXAS AVE
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:
78201-5944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-736-4238
Provider Business Practice Location Address Fax Number:
210-737-7151
Provider Enumeration Date:
06/28/2005