Provider First Line Business Practice Location Address:
4901 E UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
ATHLETIC TRAINING- GYM ROOM 111
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79762-8122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-552-2679
Provider Business Practice Location Address Fax Number:
432-552-3681
Provider Enumeration Date:
08/31/2014