Provider First Line Business Practice Location Address:
16 S JOHNSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALICE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78332-4532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-664-8118
Provider Business Practice Location Address Fax Number:
361-668-1848
Provider Enumeration Date:
08/17/2006