Provider First Line Business Practice Location Address:
6910 HWY 80
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRAIRIE LEA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-488-2328
Provider Business Practice Location Address Fax Number:
512-488-2425
Provider Enumeration Date:
02/13/2007