Provider First Line Business Practice Location Address:
1657 SAM HOUSTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-8123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-428-8301
Provider Business Practice Location Address Fax Number:
956-428-5291
Provider Enumeration Date:
11/27/2007