Provider First Line Business Practice Location Address:
216 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANTHONY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79821-9304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-886-3005
Provider Business Practice Location Address Fax Number:
915-886-3005
Provider Enumeration Date:
08/15/2006