Provider First Line Business Practice Location Address:
UNIVERSITY OF THE INCARNATE WORD
Provider Second Line Business Practice Location Address:
4301 BROADWAY, CPO #99
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-883-1080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2006