Provider First Line Business Practice Location Address:
313 COUNTY ROAD 4711
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEMPNER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76539-5867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-288-8096
Provider Business Practice Location Address Fax Number:
245-288-8970
Provider Enumeration Date:
11/03/2006