Provider First Line Business Practice Location Address:
1212 N 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:
78363-4013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-592-1292
Provider Business Practice Location Address Fax Number:
361-592-5639
Provider Enumeration Date:
03/01/2007