Provider First Line Business Practice Location Address:
501 CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SABINAL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78881-0104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-988-2233
Provider Business Practice Location Address Fax Number:
830-988-2217
Provider Enumeration Date:
02/21/2007