Provider First Line Business Practice Location Address: 
6 MEDICAL CENTER BLVD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
LUFKIN
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
75904-3163
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
936-634-0526
    Provider Business Practice Location Address Fax Number: 
936-634-0529
    Provider Enumeration Date: 
03/26/2007