Provider First Line Business Practice Location Address:
1325 S 77 SUNSHINE STRIP
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-428-8582
Provider Business Practice Location Address Fax Number:
956-428-8520
Provider Enumeration Date:
10/23/2006