Provider First Line Business Practice Location Address:
559 MEDICAL SQUADRON
Provider Second Line Business Practice Location Address:
221 THIRD STREET W BLDG 1040
Provider Business Practice Location Address City Name:
UNIVERSAL CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-916-9900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2011