Provider First Line Business Practice Location Address:
1429 S 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78363-6253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-516-1080
Provider Business Practice Location Address Fax Number:
361-516-1076
Provider Enumeration Date:
07/18/2006