Provider First Line Business Practice Location Address:
4501 HALE AVE
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-9296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-365-4677
Provider Business Practice Location Address Fax Number:
956-365-4622
Provider Enumeration Date:
04/08/2008