Provider First Line Business Practice Location Address:
120 AUSTIN HWY STE 101
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:
78209-5339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-805-8446
Provider Business Practice Location Address Fax Number:
210-805-0415
Provider Enumeration Date:
08/31/2006