Provider First Line Business Practice Location Address:
111 WEST 4TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALE CENTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-839-2484
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2007