Provider First Line Business Practice Location Address:
2401 SOUTH 31ST STREET
Provider Second Line Business Practice Location Address:
CREDENTIALING SERVICES DEPT. OF MEDICAL STAFF SERVICES
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76503-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-724-0982
Provider Business Practice Location Address Fax Number:
254-724-0548
Provider Enumeration Date:
12/31/2009