Provider First Line Business Practice Location Address:
100 W. DEAN KEATON DRIVE
Provider Second Line Business Practice Location Address:
HEALTH PROMOTION RESOURCE CENTER, SSB 1.106
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-475-8252
Provider Business Practice Location Address Fax Number:
512-475-8459
Provider Enumeration Date:
07/27/2009