Provider First Line Business Practice Location Address:
1622 N ED CAREY DR
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:
78550-8286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-428-4258
Provider Business Practice Location Address Fax Number:
956-428-4292
Provider Enumeration Date:
05/27/2005