Provider First Line Business Practice Location Address:
116 WEST 6TH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALE CENTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79041-9586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-839-2221
Provider Business Practice Location Address Fax Number:
888-972-3563
Provider Enumeration Date:
01/26/2007