Provider First Line Business Practice Location Address:
28217 BASS BLVD
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:
78552-2139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-425-6033
Provider Business Practice Location Address Fax Number:
956-425-6033
Provider Enumeration Date:
10/24/2006