Provider First Line Business Practice Location Address:
700 E. MARSHALL AVE
Provider Second Line Business Practice Location Address:
GOOD SHEPHERD MEDICAL CENTER
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75601-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-291-1667
Provider Business Practice Location Address Fax Number:
903-291-1792
Provider Enumeration Date:
04/08/2013