Provider First Line Business Practice Location Address:
501 WALNUT STREET
Provider Second Line Business Practice Location Address:
CORRECTIONAL MEDICAL SERVICES
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71854-0809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-216-1256
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2006