Provider First Line Business Practice Location Address:
602 E CAMPBELL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KERMIT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-586-3477
Provider Business Practice Location Address Fax Number:
432-586-2664
Provider Enumeration Date:
02/20/2007