Provider First Line Business Practice Location Address:
113 5TH ST
Provider Second Line Business Practice Location Address:
PO BOX 1085
Provider Business Practice Location Address City Name:
ODEM
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-738-9490
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2025