Provider First Line Business Practice Location Address:
1074 E MCCARTY LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-829-0273
Provider Business Practice Location Address Fax Number:
800-878-9191
Provider Enumeration Date:
10/19/2026