Provider First Line Business Practice Location Address:
2814 E CARLOS TRUAN BLVD
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:
78363-8934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-442-2362
Provider Business Practice Location Address Fax Number:
361-595-4849
Provider Enumeration Date:
09/27/2006