Provider First Line Business Practice Location Address:
1400 S 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78363-6359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-592-7702
Provider Business Practice Location Address Fax Number:
361-592-7769
Provider Enumeration Date:
08/31/2006