Provider First Line Business Practice Location Address:
1117 S COMMERCE ST
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:
78550-7706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-423-1753
Provider Business Practice Location Address Fax Number:
956-423-2955
Provider Enumeration Date:
08/30/2006