Provider First Line Business Practice Location Address:
10064 ALAMEDA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOCORRO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79927-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-252-7600
Provider Business Practice Location Address Fax Number:
214-252-7599
Provider Enumeration Date:
07/31/2015