Provider First Line Business Practice Location Address:
401 JAMES RICHARD CLOSNER DR
Provider Second Line Business Practice Location Address:
A BOX 1
Provider Business Practice Location Address City Name:
LA FERIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78559-3057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-797-9999
Provider Business Practice Location Address Fax Number:
956-797-9990
Provider Enumeration Date:
11/13/2006