Provider First Line Business Practice Location Address:
1012 W WICHITA AVE
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:
78550-4643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-638-5871
Provider Business Practice Location Address Fax Number:
956-428-2363
Provider Enumeration Date:
06/19/2007