Provider First Line Business Practice Location Address:
1123 E 12TH ST
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:
78520-7023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-544-2421
Provider Business Practice Location Address Fax Number:
956-544-1136
Provider Enumeration Date:
08/14/2007