Provider First Line Business Practice Location Address:
304 S. 22ND ST
Provider Second Line Business Practice Location Address:
CENTRAL COUNTIES MH MR
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76501-7003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-298-7000
Provider Business Practice Location Address Fax Number:
254-298-7003
Provider Enumeration Date:
08/11/2006