Provider First Line Business Practice Location Address:
8500 FM 1283
Provider Second Line Business Practice Location Address:
STE L
Provider Business Practice Location Address City Name:
LAKEHILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-612-2626
Provider Business Practice Location Address Fax Number:
830-612-2628
Provider Enumeration Date:
06/19/2005