Provider First Line Business Practice Location Address:
1210 E 8TH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
WESLACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78596-7111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-968-8523
Provider Business Practice Location Address Fax Number:
956-969-1761
Provider Enumeration Date:
10/14/2010