Provider First Line Business Practice Location Address: 
1401 S RANGERVILLE RD
    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: 
78552-7638
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
956-364-8000
    Provider Business Practice Location Address Fax Number: 
956-364-8189
    Provider Enumeration Date: 
02/28/2018