Provider First Line Business Practice Location Address:
10950 US HWY 87 NORTH
Provider Second Line Business Practice Location Address:
BOX 38
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76934-0038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-465-2880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2006