Provider First Line Business Practice Location Address:
4400 S M L KING JR PKWY
Provider Second Line Business Practice Location Address:
CARDINAL COMMUNITY CLINIC, EDUCATION BUILDING ROOM 115
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77705-5748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-880-7681
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2015