Provider First Line Business Practice Location Address:
2001 W 5TH ST
Provider Second Line Business Practice Location Address:
LOCUM TENON
Provider Business Practice Location Address City Name:
FORT STOCKTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79735-6231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-290-0116
Provider Business Practice Location Address Fax Number:
432-336-2256
Provider Enumeration Date:
02/12/2009