Provider First Line Business Practice Location Address:
1710 STATE HIGHWAY 100 STE S
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:
78578-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-495-8658
Provider Business Practice Location Address Fax Number:
956-548-1198
Provider Enumeration Date:
12/11/2008