Provider First Line Business Practice Location Address:
120 UPTOWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78520-7559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-982-0909
Provider Business Practice Location Address Fax Number:
956-982-0921
Provider Enumeration Date:
06/14/2006