Provider First Line Business Practice Location Address:
1104 W SAM HOUSTON ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PHARR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78577-5104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-781-0031
Provider Business Practice Location Address Fax Number:
956-781-0202
Provider Enumeration Date:
08/18/2006