Provider First Line Business Practice Location Address:
5048 E US HIGHWAY 83 STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIO GRANDE CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78582-9417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-352-7084
Provider Business Practice Location Address Fax Number:
956-984-6120
Provider Enumeration Date:
09/02/2026