Provider First Line Business Practice Location Address:
4230 GARDENDALE ST
Provider Second Line Business Practice Location Address:
BLDG. 201
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-691-2747
Provider Business Practice Location Address Fax Number:
210-691-2872
Provider Enumeration Date:
12/27/2006