Provider First Line Business Practice Location Address:
401 TEMPLE HALL HWY STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANBURY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76049-8104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-279-1665
Provider Business Practice Location Address Fax Number:
817-533-2832
Provider Enumeration Date:
10/14/2008