Provider First Line Business Practice Location Address:
# 1 FERRY ROAD
Provider Second Line Business Practice Location Address:
HEALTH SERVICES DIVISION
Provider Business Practice Location Address City Name:
GALVESTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77553-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-766-4776
Provider Business Practice Location Address Fax Number:
409-766-4765
Provider Enumeration Date:
10/31/2006