Provider First Line Business Practice Location Address:
791 BACKHAUS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIPE CREEK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78063-5615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-325-4870
Provider Business Practice Location Address Fax Number:
210-447-7909
Provider Enumeration Date:
03/19/2026