Provider First Line Business Practice Location Address:
5505 S. EXPRESSWAY 77/83 STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-423-5646
Provider Business Practice Location Address Fax Number:
956-423-5652
Provider Enumeration Date:
10/13/2010