Provider First Line Business Practice Location Address:
112 W QUEEN ISABELLA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ISABEL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78578-2969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-443-3470
Provider Business Practice Location Address Fax Number:
361-552-0195
Provider Enumeration Date:
02/20/2013