Provider First Line Business Practice Location Address:
9963A ALAMEDA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOCORRO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79927-2963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-872-0477
Provider Business Practice Location Address Fax Number:
915-872-0484
Provider Enumeration Date:
11/15/2005