Provider First Line Business Practice Location Address:
9547 HUEBNER RD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78240-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-699-0079
Provider Business Practice Location Address Fax Number:
210-699-0910
Provider Enumeration Date:
12/14/2006