Provider First Line Business Practice Location Address:
23250 FARM ROAD 170
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERLINGUA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79852-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-371-2536
Provider Business Practice Location Address Fax Number:
432-371-2546
Provider Enumeration Date:
06/05/2006