Provider First Line Business Practice Location Address:
8020 BLANCO 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:
78216-3702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-344-4553
Provider Business Practice Location Address Fax Number:
210-366-3728
Provider Enumeration Date:
09/30/2005