Provider First Line Business Practice Location Address:
OJ BAKER AT REDA BLAND EVANS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRAIRIE VIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-857-2511
Provider Business Practice Location Address Fax Number:
936-857-4999
Provider Enumeration Date:
11/24/2006