Provider First Line Business Practice Location Address:
1315 WALNUT
Provider Second Line Business Practice Location Address:
TEMPLE MEMORIAL REHAB CTR
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-794-2705
Provider Business Practice Location Address Fax Number:
903-793-1203
Provider Enumeration Date:
09/07/2006