Provider First Line Business Practice Location Address:
526 CAMDEN 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:
78215-1924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-222-2990
Provider Business Practice Location Address Fax Number:
210-227-5575
Provider Enumeration Date:
10/04/2005