Provider First Line Business Practice Location Address:
1050 CHICKEN RANCH RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ELIZARIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-494-5070
Provider Business Practice Location Address Fax Number:
915-872-3927
Provider Enumeration Date:
12/07/2021