Provider First Line Business Practice Location Address:
ELLIS PRISON
Provider Second Line Business Practice Location Address:
1697 FM 980
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77343-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-295-5756
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2009