Provider First Line Business Practice Location Address:
1958 AUSTIN HWY
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:
78218-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-590-9696
Provider Business Practice Location Address Fax Number:
210-650-9696
Provider Enumeration Date:
12/23/2006