Provider First Line Business Practice Location Address:
1001 E UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
PROTHRO CENTER, SUITE 200
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78626-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-863-1252
Provider Business Practice Location Address Fax Number:
512-863-1814
Provider Enumeration Date:
02/08/2013