Provider First Line Business Practice Location Address: 
1206 S F ST STE 1
    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: 
78550-6783
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
956-444-0844
    Provider Business Practice Location Address Fax Number: 
956-444-0845
    Provider Enumeration Date: 
02/20/2008