Provider First Line Business Practice Location Address:
100 W DEAN KEETON ST
Provider Second Line Business Practice Location Address:
CAMPUS MAIL A3900 (UHS) OR CAMPUS MAIL A3500 (CMHC)
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-471-4955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2006