Provider First Line Business Practice Location Address:
1402 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:
78596-6638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-968-2117
Provider Business Practice Location Address Fax Number:
956-968-8287
Provider Enumeration Date:
09/21/2006