Provider First Line Business Practice Location Address:
928 BLACKSON
Provider Second Line Business Practice Location Address:
FAR NORTH COMMUNITY HEALTH CENTER
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-972-4170
Provider Business Practice Location Address Fax Number:
512-323-5967
Provider Enumeration Date:
05/27/2006