Provider First Line Business Practice Location Address:
3200 RED RIVER ST.
Provider Second Line Business Practice Location Address:
SUITE 201 TEXAS SPORTS & FAMILY MEDICINE
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78705-2655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-473-0201
Provider Business Practice Location Address Fax Number:
512-473-0202
Provider Enumeration Date:
01/30/2009