Provider First Line Business Practice Location Address:
2217 PADRE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH PADRE ISLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-761-4649
Provider Business Practice Location Address Fax Number:
866-594-1025
Provider Enumeration Date:
10/22/2009