Provider First Line Business Practice Location Address:
102 S UNIVERSITY BLVD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-355-4040
Provider Business Practice Location Address Fax Number:
361-355-4159
Provider Enumeration Date:
03/16/2020