Provider First Line Business Practice Location Address:
5342 E HWY 83, C1
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-488-9900
Provider Business Practice Location Address Fax Number:
956-488-9910
Provider Enumeration Date:
08/03/2006