Provider First Line Business Practice Location Address:
1002 WEST SAM HOUSTON
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
PHARR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-283-0911
Provider Business Practice Location Address Fax Number:
956-283-1884
Provider Enumeration Date:
11/10/2006