Provider First Line Business Practice Location Address:
9969 FREDERICKSBURG RD
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:
78240-4106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-690-2273
Provider Business Practice Location Address Fax Number:
210-581-8209
Provider Enumeration Date:
07/07/2005