Provider First Line Business Practice Location Address:
501 W KENNEDALE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEDALE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76060-4619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-478-8077
Provider Business Practice Location Address Fax Number:
817-483-5009
Provider Enumeration Date:
12/19/2005