Provider First Line Business Practice Location Address:
1400 WEST 2ND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERCEDES
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-565-5837
Provider Business Practice Location Address Fax Number:
956-565-5842
Provider Enumeration Date:
11/14/2006