Provider First Line Business Practice Location Address:
112 W QUEEN ISABELLA STE C
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:
78578-2970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-524-0555
Provider Business Practice Location Address Fax Number:
956-524-0405
Provider Enumeration Date:
04/05/2010