Provider First Line Business Practice Location Address: 
1901 S 1ST ST
    Provider Second Line Business Practice Location Address: 
CENTRAL TEXAS HEALTH CARE SYSTEM
    Provider Business Practice Location Address City Name: 
TEMPLE
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
76504-7451
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
254-743-0542
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/20/2006