Provider First Line Business Practice Location Address:
126 MEDICAL DR.
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PALESTINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-729-4566
Provider Business Practice Location Address Fax Number:
903-729-6864
Provider Enumeration Date:
09/28/2006