Provider First Line Business Practice Location Address:
105 E. INTERSTATE 2
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
PHARR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78577-6560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-783-1818
Provider Business Practice Location Address Fax Number:
956-783-7709
Provider Enumeration Date:
11/10/2006