Provider First Line Business Practice Location Address:
105 MEDICAL PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SULPHUR SPRINGS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75482-2136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-438-3336
Provider Business Practice Location Address Fax Number:
903-438-3385
Provider Enumeration Date:
03/18/2006