Provider First Line Business Practice Location Address:
309 W SABINE ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
CARTHAGE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75633-2550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-693-3664
Provider Business Practice Location Address Fax Number:
903-693-5878
Provider Enumeration Date:
03/01/2007