Provider First Line Business Practice Location Address:
613 COUNTY ROAD 3150
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:
76539-8713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-458-1627
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2007