Provider First Line Business Practice Location Address:
1214 DIXIELAND RD
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78552-3351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-440-7336
Provider Business Practice Location Address Fax Number:
956-230-0940
Provider Enumeration Date:
09/14/2006