Provider First Line Business Practice Location Address:
418 S 6TH 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:
78363-5519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-516-1601
Provider Business Practice Location Address Fax Number:
361-516-1633
Provider Enumeration Date:
10/25/2007