Provider First Line Business Practice Location Address:
1021 SENATOR CARLOS TRUAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78363-6667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-595-5556
Provider Business Practice Location Address Fax Number:
361-595-0295
Provider Enumeration Date:
09/20/2006