Provider First Line Business Practice Location Address:
1114 HARRIS 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:
78550-1978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-536-4587
Provider Business Practice Location Address Fax Number:
956-425-6921
Provider Enumeration Date:
10/12/2011