Provider First Line Business Practice Location Address:
1901 SOUTH 1ST STREET
Provider Second Line Business Practice Location Address:
IMAGING SERVICE (114T)
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76504-7451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-743-0875
Provider Business Practice Location Address Fax Number:
254-742-4682
Provider Enumeration Date:
10/12/2005