Provider First Line Business Practice Location Address:
401 W. WALLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN SABA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-372-3033
Provider Business Practice Location Address Fax Number:
325-372-5961
Provider Enumeration Date:
08/30/2006