Provider First Line Business Practice Location Address:
1315 W POLK ST
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
PHARR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78577-2135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-781-6530
Provider Business Practice Location Address Fax Number:
956-781-6539
Provider Enumeration Date:
10/31/2005