Provider First Line Business Practice Location Address:
6.124 MCCULLOUGH BLDG.
Provider Second Line Business Practice Location Address:
UNIV. TEXAS MEDICAL BRANCH - DEPT. SURGERY DIV. PLASTIC
Provider Business Practice Location Address City Name:
GALVESTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77555-0724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-772-1255
Provider Business Practice Location Address Fax Number:
409-772-1872
Provider Enumeration Date:
05/15/2006