Provider First Line Business Practice Location Address: 
HARPER VFD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HARPER
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
78631-0306
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
830-864-4253
    Provider Business Practice Location Address Fax Number: 
830-864-5778
    Provider Enumeration Date: 
01/03/2006