Provider First Line Business Practice Location Address:
13150 NW MILITARY HWY
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:
78231-1961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-492-0111
Provider Business Practice Location Address Fax Number:
210-202-5122
Provider Enumeration Date:
11/09/2006