Provider First Line Business Practice Location Address:
155 B UPTOWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-739-1886
Provider Business Practice Location Address Fax Number:
956-546-5201
Provider Enumeration Date:
10/12/2006