Provider First Line Business Practice Location Address: 
1915 S GREGG ST
    Provider Second Line Business Practice Location Address: 
FAMILIA DENTAL
    Provider Business Practice Location Address City Name: 
BIG SPRINGS
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
79720
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
432-264-0205
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/19/2021