Provider First Line Business Practice Location Address:
13417 SAN PEDRO AVE
Provider Second Line Business Practice Location Address:
SAN PEDRO SQUARE SHOPPING CENTER
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78216-2058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-496-6549
Provider Business Practice Location Address Fax Number:
210-496-6237
Provider Enumeration Date:
02/15/2007