Provider First Line Business Practice Location Address:
1212 MEDICAL PLAZA CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANBURY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-279-1776
Provider Business Practice Location Address Fax Number:
817-279-7206
Provider Enumeration Date:
07/07/2005