Provider First Line Business Practice Location Address:
4937 RUSTIC TRL
Provider Second Line Business Practice Location Address:
MIDLAND UROLOGY CTR
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79707-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-699-2526
Provider Business Practice Location Address Fax Number:
432-699-1141
Provider Enumeration Date:
07/19/2005