Provider First Line Business Practice Location Address:
1954 E HOUSTON ST
Provider Second Line Business Practice Location Address:
RM 202
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78202-2953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-225-5804
Provider Business Practice Location Address Fax Number:
210-225-1046
Provider Enumeration Date:
06/20/2005