Provider First Line Business Practice Location Address:
4400 MLK JR. PKWY
Provider Second Line Business Practice Location Address:
LAMAR UNIVERSITY, 115 EDUCATION BUILDING
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77710-0034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-880-7954
Provider Business Practice Location Address Fax Number:
409-880-2263
Provider Enumeration Date:
02/18/2015