Provider First Line Business Practice Location Address:
1305 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:
78363-6356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-595-1986
Provider Business Practice Location Address Fax Number:
361-595-1478
Provider Enumeration Date:
03/14/2007