Provider First Line Business Practice Location Address:
401 E KING AVE
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:
78363-5666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-221-2943
Provider Business Practice Location Address Fax Number:
361-221-2944
Provider Enumeration Date:
02/12/2019