Provider First Line Business Practice Location Address:
1002 W SAM HOUSTON ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
PHARR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78577-5224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-783-1400
Provider Business Practice Location Address Fax Number:
956-783-8818
Provider Enumeration Date:
05/10/2006