Provider First Line Business Practice Location Address:
3001 S US HWY 83
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZAPATA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78076-0786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-765-0500
Provider Business Practice Location Address Fax Number:
956-765-0504
Provider Enumeration Date:
05/17/2007