Provider First Line Business Practice Location Address:
2308 EXPRESSWAY 83 STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENITAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78576-8399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-271-1064
Provider Business Practice Location Address Fax Number:
956-271-1068
Provider Enumeration Date:
11/07/2006