Provider First Line Business Practice Location Address:
606 W LELA ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-4876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-412-9400
Provider Business Practice Location Address Fax Number:
956-412-9407
Provider Enumeration Date:
10/03/2006