Provider First Line Business Practice Location Address:
219 E LOCUST ST
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:
78212-3955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-805-8330
Provider Business Practice Location Address Fax Number:
210-333-1833
Provider Enumeration Date:
07/18/2006