Provider First Line Business Practice Location Address:
2308 HWY 83 STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENITAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78576-8399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-584-6700
Provider Business Practice Location Address Fax Number:
956-583-7793
Provider Enumeration Date:
06/25/2009