Provider First Line Business Practice Location Address:
1138 E INTERSTATE 2 STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHARR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78577-6519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-782-5447
Provider Business Practice Location Address Fax Number:
956-782-5448
Provider Enumeration Date:
02/26/2015