Provider First Line Business Practice Location Address:
401 S KANSAS AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
WESLACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78596-6214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-854-4424
Provider Business Practice Location Address Fax Number:
956-854-4430
Provider Enumeration Date:
06/22/2006