Provider First Line Business Practice Location Address:
5655 HIGHWAY 35 S
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:
78211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-977-8273
Provider Business Practice Location Address Fax Number:
210-977-8274
Provider Enumeration Date:
11/13/2006