Provider First Line Business Practice Location Address:
4000 S LOOP 256
Provider Second Line Business Practice Location Address:
SLEEP DISORDERS CENTER, PRRH
Provider Business Practice Location Address City Name:
PALESTINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75801-8467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-731-5264
Provider Business Practice Location Address Fax Number:
903-731-5202
Provider Enumeration Date:
10/11/2005