Provider First Line Business Practice Location Address:
25224 N KANSAS CITY RD
Provider Second Line Business Practice Location Address:
LA FERIA
Provider Business Practice Location Address City Name:
LA FERIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78559-4513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-893-3144
Provider Business Practice Location Address Fax Number:
956-565-6265
Provider Enumeration Date:
10/26/2009