Provider First Line Business Practice Location Address:
1112 GARNER FIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UVALDE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78801-4812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-278-8440
Provider Business Practice Location Address Fax Number:
830-278-7820
Provider Enumeration Date:
03/21/2007