Provider First Line Business Practice Location Address:
8509 FM 969, BUILDING 627
Provider Second Line Business Practice Location Address:
C/O KIPP AUSTIN COLLEGE PREP
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-673-6102
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2015