Provider First Line Business Practice Location Address:
500 S DR EE DUNLAP ST STE A&B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78384-3212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-279-7159
Provider Business Practice Location Address Fax Number:
361-279-7256
Provider Enumeration Date:
02/10/2011