Provider First Line Business Practice Location Address:
1126 S 14TH STREET
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
KINGSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-595-5521
Provider Business Practice Location Address Fax Number:
361-595-1801
Provider Enumeration Date:
01/30/2007