Provider First Line Business Practice Location Address:
1954 EAST HOUSTON STREET SUITE 208
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:
78204-2951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-222-2997
Provider Business Practice Location Address Fax Number:
210-354-2241
Provider Enumeration Date:
10/24/2006