Provider First Line Business Practice Location Address:
12800 SH 64E
Provider Second Line Business Practice Location Address:
CHAPEL HILL ISD, KISSAM INTERMEDIATE SCHOOL
Provider Business Practice Location Address City Name:
TYLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75707-7570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-566-8334
Provider Business Practice Location Address Fax Number:
903-565-5195
Provider Enumeration Date:
05/26/2022