Provider First Line Business Practice Location Address:
1000 W CORRAL AVE
Provider Second Line Business Practice Location Address:
UNIT #1001
Provider Business Practice Location Address City Name:
KINGSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78363-3035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-595-0783
Provider Business Practice Location Address Fax Number:
361-595-1929
Provider Enumeration Date:
01/22/2007