Provider First Line Business Practice Location Address:
1703 W OWASSA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78539-7047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-682-2273
Provider Business Practice Location Address Fax Number:
956-682-8732
Provider Enumeration Date:
03/01/2007