Provider First Line Business Practice Location Address:
200 TAYLOR STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARKSDALE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-234-3514
Provider Business Practice Location Address Fax Number:
830-234-3435
Provider Enumeration Date:
09/30/2011