Provider First Line Business Practice Location Address:
202 SECOND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ISABEL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78578-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-943-1774
Provider Business Practice Location Address Fax Number:
956-421-2787
Provider Enumeration Date:
07/12/2007