Provider First Line Business Practice Location Address:
1901 S 1ST ST
Provider Second Line Business Practice Location Address:
CTVHCS , SATP BUILDING 146
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76504-7451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-743-1855
Provider Business Practice Location Address Fax Number:
254-743-0495
Provider Enumeration Date:
08/31/2006