Provider First Line Business Practice Location Address:
119 N 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78363-4622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-592-6445
Provider Business Practice Location Address Fax Number:
361-595-4798
Provider Enumeration Date:
10/26/2006