Provider First Line Business Practice Location Address: 
333 N. SANTA ROSA
    Provider Second Line Business Practice Location Address: 
GOLDSBURY CENTER FOR CHILDREN AND FAMILIES
    Provider Business Practice Location Address City Name: 
SAN ANTONIO
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
78207-3108
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
210-704-2925
    Provider Business Practice Location Address Fax Number: 
210-704-3765
    Provider Enumeration Date: 
08/24/2006