Provider First Line Business Practice Location Address:
224 W. KING
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-221-9809
Provider Business Practice Location Address Fax Number:
361-221-9510
Provider Enumeration Date:
11/28/2006