Provider First Line Business Practice Location Address:
2000 E SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KERMIT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79745-5205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-586-6665
Provider Business Practice Location Address Fax Number:
432-586-8849
Provider Enumeration Date:
10/07/2005