Provider First Line Business Practice Location Address:
21254 CAMPBELLTON 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:
78264-4410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-626-3030
Provider Business Practice Location Address Fax Number:
210-626-3030
Provider Enumeration Date:
11/20/2006