Provider First Line Business Practice Location Address:
950 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
#101 LONGHORN DENTAL GEORGETOWN
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-930-5930
Provider Business Practice Location Address Fax Number:
512-869-0276
Provider Enumeration Date:
11/01/2006