Provider First Line Business Practice Location Address:
19059 STATE HIGHWAY 274
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEMP
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75143-5382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-498-3737
Provider Business Practice Location Address Fax Number:
903-498-5970
Provider Enumeration Date:
12/19/2006