Provider First Line Business Practice Location Address:
7882 S HIGHWAY 181
Provider Second Line Business Practice Location Address:
DRAWER E
Provider Business Practice Location Address City Name:
KENEDY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-583-9101
Provider Business Practice Location Address Fax Number:
830-583-2962
Provider Enumeration Date:
10/04/2005