Provider First Line Business Practice Location Address: 
800 SCOTT AND WHITE DR
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
COLLEGE STATION
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77845-6440
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
979-207-4380
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/10/2014