Provider First Line Business Practice Location Address:
12221 MOPAC EXPRESSWAY NORTH
Provider Second Line Business Practice Location Address:
DEPT OF PHARMACY
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78758-2496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-901-1413
Provider Business Practice Location Address Fax Number:
512-901-1499
Provider Enumeration Date:
07/20/2005