Provider First Line Business Practice Location Address:
412 W ORANGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78541-8385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-358-3671
Provider Business Practice Location Address Fax Number:
956-381-0385
Provider Enumeration Date:
09/30/2008