Provider First Line Business Practice Location Address:
110 UPTOWN AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78520-7563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-544-0238
Provider Business Practice Location Address Fax Number:
956-544-0386
Provider Enumeration Date:
11/01/2010