Provider First Line Business Practice Location Address:
1126 S 14TH ST
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:
78363-6371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-937-2316
Provider Business Practice Location Address Fax Number:
270-897-1758
Provider Enumeration Date:
08/04/2006