Provider First Line Business Practice Location Address:
1203 S 14TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-592-8521
Provider Business Practice Location Address Fax Number:
361-592-5860
Provider Enumeration Date:
01/16/2007