Provider First Line Business Practice Location Address:
4001 HWY 36 SOUTH
Provider Second Line Business Practice Location Address:
BRENHAM STATE SCHOOL
Provider Business Practice Location Address City Name:
BRENHAM
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77833-9611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-836-4511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2006