Provider First Line Business Practice Location Address:
425 E KING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78363-5666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-516-0751
Provider Business Practice Location Address Fax Number:
361-516-0753
Provider Enumeration Date:
11/08/2007